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General NPI Number Information
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NPI Number | 1245625292
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Entity Type | Individual
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Provider Name | PETER O'HALLORAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 1 GUTHRIE SQ
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City | SAYRE
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State | PA
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Zip | 18840-1699
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Country | US
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Telephone | 570-888-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GUTHRIE SQ
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City | SAYRE
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State | PA
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Zip | 18840-1699
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 308064
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License Number State | NY
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