Provider Demographics
NPI:1265548028
Name:O'HALLORAN, ANDREW P (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:O'HALLORAN
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 1:2768 KITTBUCK WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5748
Mailing Address - Country:US
Mailing Address - Phone:561-687-3551
Mailing Address - Fax:
Practice Address - Street 1:109 JFK DR STE C
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6617
Practice Address - Country:US
Practice Address - Phone:561-964-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229788207L00000X
FLOS 10026207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2128195Medicaid
MA2128195Medicaid