1487665261 NPI number — DAVID A HALSEY MD

Table of content: DAVID A HALSEY MD (NPI 1487665261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487665261 NPI number — DAVID A HALSEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALSEY
Provider First Name:
DAVID
Provider Middle Name:
A
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:
1487665261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGARTOWN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02539-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-563-2981
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 CURTIS LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGARTOWN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-563-2981
Provider Business Practice Location Address Fax Number:
802-847-8996
Provider Enumeration Date:
08/10/2006

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: 207X00000X , with the licence number:  268803 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0107529Y0NH0 . This is a "BLUECROSS-ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 5382 . This is a "BLUECROSS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 30004156 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0009323 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5281 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18P500 . This is a "MVP" identifier . This identifiers is of the category "OTHER".




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