Provider Demographics
NPI:1669528527
Name:HALSTED, DOUGLAS OLIVER (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:OLIVER
Last Name:HALSTED
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4 CENTENNIAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7935
Mailing Address - Country:US
Mailing Address - Phone:978-531-0800
Mailing Address - Fax:978-531-2929
Practice Address - Street 1:4 CENTENNIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7935
Practice Address - Country:US
Practice Address - Phone:978-531-0800
Practice Address - Fax:978-531-2929
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA45799207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0129372Medicaid
MAA54245Medicare UPIN
MA0129372Medicaid