Provider Demographics
NPI:1487730362
Name:HALL, CLARENCE EDWARD II (MD)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:EDWARD
Last Name:HALL
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:12522 W. COLONIAL TRAIL HWY.
Mailing Address - City:CREWE
Mailing Address - State:VA
Mailing Address - Zip Code:23930-0528
Mailing Address - Country:US
Mailing Address - Phone:434-645-9191
Mailing Address - Fax:434-645-1859
Practice Address - Street 1:12522 W. COLONIAL TRAIL HWY.
Practice Address - Street 2:
Practice Address - City:CREWE
Practice Address - State:VA
Practice Address - Zip Code:23930
Practice Address - Country:US
Practice Address - Phone:434-645-9191
Practice Address - Fax:434-645-1859
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101102561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC10089Medicare PIN
VA080007760Medicare PIN
VAH38433Medicare UPIN