Provider Demographics
NPI:1417906272
Name:HALACHANOVA, VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:
Last Name:HALACHANOVA
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 1:1032 W WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879-1545
Mailing Address - Country:US
Mailing Address - Phone:419-399-2045
Mailing Address - Fax:419-399-4389
Practice Address - Street 1:1032 W WAYNE ST
Practice Address - Street 2:
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-1545
Practice Address - Country:US
Practice Address - Phone:419-399-2045
Practice Address - Fax:419-399-4389
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078685207R00000X
OH35-078685H207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2233809Medicaid
OHH41359Medicare UPIN
OH4054682Medicare ID - Type Unspecified