Provider Demographics
NPI:1689226573
Name:HALTEMAN, TROY (PA-C)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:HALTEMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 HAYMAKER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3553
Mailing Address - Country:US
Mailing Address - Phone:412-858-4150
Mailing Address - Fax:412-373-4595
Practice Address - Street 1:2566 HAYMAKER RD STE 105
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3553
Practice Address - Country:US
Practice Address - Phone:412-858-4150
Practice Address - Fax:412-373-4595
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060840363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103652561Medicaid
14500734OtherCAQH