Provider Demographics
NPI:1225033277
Name:HALTOF, ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:HALTOF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5853
Mailing Address - Country:US
Mailing Address - Phone:207-782-2223
Mailing Address - Fax:207-783-2230
Practice Address - Street 1:86 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5853
Practice Address - Country:US
Practice Address - Phone:207-782-2223
Practice Address - Fax:207-782-2230
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1486204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133320000Medicaid
MEMM6039Medicare ID - Type Unspecified
MEG11327Medicare UPIN