Provider Demographics
NPI:1003807025
Name:HALLEY, JEFFREY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:HALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 DEBARTOLO PL
Mailing Address - Street 2:SUITE 2750
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7004
Mailing Address - Country:US
Mailing Address - Phone:330-758-7703
Mailing Address - Fax:330-758-4930
Practice Address - Street 1:250 DEBARTOLO PL
Practice Address - Street 2:SUITE 2750
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-7004
Practice Address - Country:US
Practice Address - Phone:330-758-7703
Practice Address - Fax:330-758-4930
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060338207RC0000X, 207R00000X
PAMD420867207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161328Medicaid
PA01766785Medicaid
OHG07396Medicare UPIN
OHHA0786943Medicare ID - Type Unspecified
PA01766785Medicaid