Provider Demographics
NPI:1952310856
Name:HALTERMAN, MARC WHITNEY (MD, PHD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:WHITNEY
Last Name:HALTERMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-216-8527
Mailing Address - Fax:631-759-2750
Practice Address - Street 1:101 NICOLLS RD RM 20
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-216-8527
Practice Address - Fax:631-759-2750
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2361252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02785573Medicaid
NYRB3432Medicare PIN