Provider Demographics
NPI:1720297849
Name:HALTER, JEFFREY M (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:HALTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:887 CONGRESS ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-5555
Practice Address - Fax:207-662-5526
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME0177902086S0120X
OH35-0895042086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207763Medicaid
ME432923399Medicaid
ME432923399Medicaid