Provider Demographics
NPI:1992908479
Name:DAVID M. HALLBERT, MD LLC
Entity type:Organization
Organization Name:DAVID M. HALLBERT, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:HALLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-338-5353
Mailing Address - Street 1:16 FAHEY ST STE 108
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6029
Mailing Address - Country:US
Mailing Address - Phone:207-338-5353
Mailing Address - Fax:207-338-0146
Practice Address - Street 1:16 FAHEY ST STE 108
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6029
Practice Address - Country:US
Practice Address - Phone:207-338-5353
Practice Address - Fax:207-338-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER014171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME046818OtherANTHEM PROVIDER NUMBER
ME046818OtherANTHEM PROVIDER NUMBER
MEME0428Medicare ID - Type Unspecified
ME=========OtherTAX ID NUMBER