1235586546 NPI number — MATTHEW JAY HALLMAN M.D.

Table of content: MATTHEW JAY HALLMAN M.D. (NPI 1235586546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235586546 NPI number — MATTHEW JAY HALLMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALLMAN
Provider First Name:
MATTHEW
Provider Middle Name:
JAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1235586546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 HUFF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28546-7369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-353-4414
Provider Business Mailing Address Fax Number:
910-353-2972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 MCCARTHY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BERN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28562-5233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-672-0095
Provider Business Practice Location Address Fax Number:
252-672-9897
Provider Enumeration Date:
05/17/2016

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: 207L00000X , with the licence number:  218054 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 2020-03533 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 218054 . This is a "NORTH CAROLINA MEDICAL BOARD GRADUATE MEDICAL TRAINING LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 218054 . This is a "NCMB CERTIFICATE NUMBER (FULL LICENSE ATTAINED 2020)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".