Provider Demographics
NPI:1184172728
Name:HALFORD, MARK A (HAD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:HALFORD
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 ROUTE 38
Mailing Address - Street 2:SUITE #19
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9757
Mailing Address - Country:US
Mailing Address - Phone:856-234-8844
Mailing Address - Fax:856-866-7593
Practice Address - Street 1:3131 ROUTE 38
Practice Address - Street 2:SUITE #19
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9757
Practice Address - Country:US
Practice Address - Phone:856-234-8844
Practice Address - Fax:856-866-7593
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00140500237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist