MEDICARE: DR. PHILIP W HALSTEAD M.D.

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	207R00000X	Internal Medicine Physician	D0050803	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962405704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP W HALSTEAD M.D.

Provider Business Mailing Address
First Line	:	602 S ATWOOD RD
Second Line	:	SUITE 101
City	:	BEL AIR
State	:	MD
Zip	:	21014-4172
Country	:	US
Telephone Number	:	410-420-0396
Fax Number	:	410-638-8270

Provider Business Practice Location Address
First Line	:	602 S ATWOOD RD
Second Line	:	SUITE 101
City	:	BEL AIR
State	:	MD
Zip	:	21014-4172
Country	:	US
Telephone Number	:	410-420-0396
Fax Number	:	410-638-8270

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/15/2007

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