Provider Demographics
NPI:1053636506
Name:HALVORSON, CHRISTIAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:R
Last Name:HALVORSON
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 1:54 SCOTT ADAM RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3216
Mailing Address - Country:US
Mailing Address - Phone:410-666-3960
Mailing Address - Fax:410-666-3981
Practice Address - Street 1:54 SCOTT ADAM RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-3216
Practice Address - Country:US
Practice Address - Phone:410-666-3960
Practice Address - Fax:410-666-3981
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0077595207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology