Provider Demographics
NPI:1962405704
Name:HALSTEAD, PHILIP W (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:W
Last Name:HALSTEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:602 S ATWOOD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4172
Mailing Address - Country:US
Mailing Address - Phone:410-420-0396
Mailing Address - Fax:410-638-8270
Practice Address - Street 1:602 S ATWOOD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4172
Practice Address - Country:US
Practice Address - Phone:410-420-0396
Practice Address - Fax:410-638-8270
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0050803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD807240000Medicaid
MDF72129Medicare UPIN
MD807240000Medicaid