Provider Demographics
NPI:1063598993
Name:HALTERMAN, JON M (PA-C)
Entity type:Individual
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First Name:JON
Middle Name:M
Last Name:HALTERMAN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2780
Mailing Address - Country:US
Mailing Address - Phone:207-523-5901
Mailing Address - Fax:207-523-5902
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-523-5901
Practice Address - Fax:207-523-5902
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-02-08
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Provider Licenses
StateLicense IDTaxonomies
MEPA-792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant