Provider Demographics
NPI:1063505121
Name:HALASZ, MIRELA I (MD)
Entity Type:Individual
Prefix:
First Name:MIRELA
Middle Name:I
Last Name:HALASZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 COMMERCE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-3874
Mailing Address - Country:US
Mailing Address - Phone:304-292-7535
Mailing Address - Fax:304-292-7537
Practice Address - Street 1:40 COMMERCE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-3874
Practice Address - Country:US
Practice Address - Phone:304-292-7535
Practice Address - Fax:304-292-7537
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
No283Q00000XHospitalsPsychiatric Hospital
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056334Medicare PIN
PAH58788Medicare UPIN