Provider Demographics
NPI:1790876951
Name:HALPERN, VIVIENNE J (MD)
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:J
Last Name:HALPERN
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 1:650 E INDIAN SCHOOL RD
Mailing Address - Street 2:PHOENIX VA HEALTH CARE SYSTEM-SURGICAL SERVICES
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1839
Mailing Address - Country:US
Mailing Address - Phone:602-277-5551
Mailing Address - Fax:602-222-2705
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:PHOENIX VA HEALTH CARE SYSTEM-SURGICAL SERVICES
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-222-2705
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY177397208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01576145Medicaid
NY01576145Medicaid
NY01770Medicare ID - Type Unspecified