Provider Demographics
NPI:1134199219
Name:HALTER, MICHAEL R (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:HALTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1802
Mailing Address - Country:US
Mailing Address - Phone:814-684-3101
Mailing Address - Fax:814-684-5539
Practice Address - Street 1:225 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1802
Practice Address - Country:US
Practice Address - Phone:814-684-3101
Practice Address - Fax:814-684-5539
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006556L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011699530004Medicaid
PAE23187Medicare UPIN
PA564148Medicare ID - Type Unspecified