Provider Demographics
NPI:1891388062
Name:HALO HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:HALO HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARTHI
Authorized Official - Middle Name:S
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-613-1504
Mailing Address - Street 1:4131 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-2126
Mailing Address - Country:US
Mailing Address - Phone:610-613-1504
Mailing Address - Fax:215-935-4906
Practice Address - Street 1:4131 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-2126
Practice Address - Country:US
Practice Address - Phone:610-613-1504
Practice Address - Fax:215-935-4906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038263750001Medicaid