Basic Information
| Provider Information | |||||||||
| NPI: | 1659357689 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALLE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 143 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 157205 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042297845 | 01 | GREAT WEST | OTHER | 1659357689 | 01 | NHP | OTHER | 3184200 | 05 | MA | MEDICAID | 042297845 | 01 | TRICARE | OTHER | 042297845 | 01 | MULTI-PLAN | OTHER | 7741098 | 01 | AETNA | OTHER | J19507 | 01 | BCBSMA | OTHER | 042297845 | 01 | HCVM | OTHER | 794601 | 01 | TUFTS AND TUFTS MEDICARE PREFERRED | OTHER | 042297845 | 01 | GIC/UNICARE | OTHER | 1659357689 | 01 | FALLON | OTHER | AA188364 | 01 | HARVARD PILGRIM | OTHER | 9728913 | 01 | CIGNA | OTHER |