Provider Demographics
NPI:1962714022
Name:HALL, TRICIA ERICA (DO)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:ERICA
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HAYNES ST STE D
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4139
Mailing Address - Country:US
Mailing Address - Phone:860-533-4678
Mailing Address - Fax:860-648-0607
Practice Address - Street 1:29 HAYNES ST STE D
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4139
Practice Address - Country:US
Practice Address - Phone:860-533-4678
Practice Address - Fax:860-533-0607
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054551204D00000X, 207Q00000X
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program