Provider Demographics
NPI:1932127909
Name:HALTIWANGER, C DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:DAVID
Last Name:HALTIWANGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CATHEDRAL ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5403
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:410-837-7793
Practice Address - Street 1:1001 CATHEDRAL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5403
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:410-837-7793
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDO1801103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132190100Medicaid
MD132190100Medicaid
MD211819Medicare Oscar/Certification
MDS10908Medicare UPIN