Provider Demographics
NPI:1164409322
Name:HALBERSTADT, GARY MARSHALL (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARSHALL
Last Name:HALBERSTADT
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Gender:M
Credentials:DO
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Mailing Address - Street 1:8091 TOWNSHIP LINE RD
Mailing Address - Street 2:#107
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2494
Mailing Address - Country:US
Mailing Address - Phone:317-875-0009
Mailing Address - Fax:317-875-3993
Practice Address - Street 1:8091 TOWNSHIP LINE RD
Practice Address - Street 2:#107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2494
Practice Address - Country:US
Practice Address - Phone:317-875-0009
Practice Address - Fax:317-875-3993
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IN02000755A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics