Provider Demographics
NPI:1629009816
Name:HALSTED, MARIA ANGELINA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELINA
Last Name:HALSTED
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:PO BOX 6310
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88006-6310
Mailing Address - Country:US
Mailing Address - Phone:575-556-6400
Mailing Address - Fax:575-556-6405
Practice Address - Street 1:2530 S TELSHOR BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4951
Practice Address - Country:US
Practice Address - Phone:575-556-6400
Practice Address - Fax:575-556-6405
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0278208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17173361Medicaid
NMP00935226OtherRR MEDICARE
NMP00935226OtherRR MEDICARE
H01061Medicare UPIN