Basic Information
| Provider Information | |||||||||
| NPI: | 1427001197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALPORN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 BROOKLINE AVE | ||||||||
| Address2: | DANA - 2, POPC | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176326464 | ||||||||
| FaxNumber: | 6176326180 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 BROOKLINE AVE | ||||||||
| Address2: | DANA - 2, POPC | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176326464 | ||||||||
| FaxNumber: | 6176326180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 05/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 151005 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | 151005 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00278201 | 01 | MEDICARE RAILROAD | OTHER | 5341530 | 01 | MA | AETNA | OTHER | 0131547 | 05 | MA | MEDICAID | 014523 | 01 | TUFTS HEALTH PLAN | OTHER | 6000260 OR AA98338 | 01 | MA | HARVARD PILGRIM | OTHER | 1427001197 | 01 | MA | NHP | OTHER | 1507407 | 01 | MA | CIGNA | OTHER | 54745 | 01 | MA | FALLON | OTHER | 97161802 | 01 | MA | NETWORK HEALTH | OTHER | J23531 | 01 | MA | BCBS MA | OTHER |