Provider Demographics
NPI:1689696809
Name:HALLOWELL, PETER T (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:T
Last Name:HALLOWELL
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 JEFFERSON PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-3363
Practice Address - Country:US
Practice Address - Phone:434-924-2150
Practice Address - Fax:434-243-9433
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244376208600000X
OH35-070624208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7911277OtherAETNA
VA1689696809Medicaid
OH738059OtherBUCKEYE
OH000000204800OtherUNISON
OH363607OtherWELLCARE
000000503725OtherANTHEM
OH2270251Medicaid
OHP00120698OtherRAILROAD MEDICARE - UHPL
7911277OtherAETNA
OH2270251Medicaid
OHP00120698OtherRAILROAD MEDICARE - UHPL