Provider Demographics
NPI:1528171014
Name:HALLORAN, CHRISTIAN C (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:C
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5026
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:210 WESTWOOD PL STE 110
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7554
Practice Address - Country:US
Practice Address - Phone:615-206-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087427207P00000X
AZ63421207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH363606OtherWELLCARE
OH745516OtherBUCKEYE MEDICAID
OH2672273Medicaid
OH7367824OtherAETNA
OH000000210486OtherUNISON
OH000000503544OtherANTHEM
OHP00370042OtherMEDICARE RAILROAD
OHP00638557Medicare PIN
OHHA4236894Medicare PIN
OH2672273Medicaid
OH363606OtherWELLCARE
OHP00689006Medicare PIN
OH745516OtherBUCKEYE MEDICAID
OHHA4236893Medicare PIN