1487640397 NPI number — ANDREW C HALPERN MD

Table of content: ANDREW C HALPERN MD (NPI 1487640397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487640397 NPI number — ANDREW C HALPERN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALPERN
Provider First Name:
ANDREW
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487640397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 732901
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75373-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-226-4590
Provider Business Mailing Address Fax Number:
386-226-3371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 BOOTH RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-5715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-523-1212
Provider Business Practice Location Address Fax Number:
386-523-1213
Provider Enumeration Date:
09/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME124133 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 223250-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64097124 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000359520 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 15D1038972 . This is a "CLIA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200063730A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016226700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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