Provider Demographics
NPI:1386872380
Name:HALDEMAN, LORI MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MARIE
Last Name:HALDEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-0392
Mailing Address - Country:US
Mailing Address - Phone:304-782-2000
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 1 BOX 75-1
Practice Address - Street 2:SALEM FAMILY MEDICINE
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-9604
Practice Address - Country:US
Practice Address - Phone:304-782-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant