Provider Demographics
NPI:1205807088
Name:HALASY, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:HALASY
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 1:280 LOONEY RD
Mailing Address - Street 2:STE 203
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4199
Mailing Address - Country:US
Mailing Address - Phone:937-778-1650
Mailing Address - Fax:937-778-3576
Practice Address - Street 1:280 LOONEY RD
Practice Address - Street 2:STE 203
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4199
Practice Address - Country:US
Practice Address - Phone:937-778-1650
Practice Address - Fax:937-778-3576
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2298722Medicaid
OHHA4081433Medicare ID - Type UnspecifiedMEDICARE
OH2298722Medicaid
OHH198220Medicare PIN