Provider Demographics
NPI:1942593603
Name:HALSTEAD, GEORGE OLIVER (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:OLIVER
Last Name:HALSTEAD
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 1:284 BLEVINS BLVD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-5977
Mailing Address - Country:US
Mailing Address - Phone:276-285-3911
Mailing Address - Fax:276-285-3920
Practice Address - Street 1:2426 LEE HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-5967
Practice Address - Country:US
Practice Address - Phone:276-285-3911
Practice Address - Fax:276-285-3920
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249165207QA0401X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty