MEDICARE: MRS. LORI MARIE HALDEMAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1386872380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI MARIE HALDEMAN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 392
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-0392
Country	:	US
Telephone Number	:	304-782-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	ROUTE 1 BOX 75-1
Second Line	:	SALEM FAMILY MEDICINE
City	:	SALEM
State	:	WV
Zip	:	26426-9604
Country	:	US
Telephone Number	:	304-782-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	04/21/2022

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