MEDICARE: JOHN ANDREW HALLBERG MD

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	207X00000X	Orthopaedic Surgery Physician	029044	CT
2	207X00000X	Orthopaedic Surgery Physician	MD07302	RI
3	207X00000X	Orthopaedic Surgery Physician	22726	WV
4	207X00000X	Orthopaedic Surgery Physician	2010-00313	NC
5	207X00000X	Orthopaedic Surgery Physician	TD131075	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	156VW	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912971508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ANDREW HALLBERG MD

Provider Business Mailing Address
First Line	:	194 E MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1428
Country	:	US
Telephone Number	:	207-834-5912
Fax Number	:	207-834-5914

Provider Business Practice Location Address
First Line	:	194 E MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1428
Country	:	US
Telephone Number	:	207-834-5912
Fax Number	:	207-834-5914

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	06/24/2013

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