Provider Demographics
NPI:1962765347
Name:HALPIN, MARK D
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:HALPIN
Suffix:
Gender:M
Credentials:
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 2624
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-2624
Mailing Address - Country:US
Mailing Address - Phone:907-226-3400
Mailing Address - Fax:907-226-3300
Practice Address - Street 1:347 W DANVIEW AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7028
Practice Address - Country:US
Practice Address - Phone:907-226-3400
Practice Address - Fax:907-226-3300
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK314067332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS2565Medicaid
AK5733300001Medicare NSC