Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | D0077595 | MD |
NPI | 1053636506 |
---|---|
Provider Name | Dr. Christian R Halvorson |
First Address | Hunt Valley, MD 21030-3216 |
Second Address | Hunt Valley, MD 21030-3216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2010 |
Last Update Date | 10/09/2018 |