Provider Demographics
NPI:1457499493
Name:HALLENBECK, JOHN MANSFIELD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MANSFIELD
Last Name:HALLENBECK
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 1:4113 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3829
Mailing Address - Country:US
Mailing Address - Phone:301-933-0656
Mailing Address - Fax:301-402-2769
Practice Address - Street 1:4113 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3829
Practice Address - Country:US
Practice Address - Phone:301-933-0656
Practice Address - Fax:301-402-2336
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO41217275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit