1376556050 NPI number — RICHARD J HARTLE MD

Table of content: RICHARD J HARTLE MD (NPI 1376556050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376556050 NPI number — RICHARD J HARTLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTLE
Provider First Name:
RICHARD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376556050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 OMNI BLVD
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-4430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-232-8769
Provider Business Mailing Address Fax Number:
757-232-8875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5424 DISCOVERY PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-2862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-206-1190
Provider Business Practice Location Address Fax Number:
757-208-0601
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  0101049148 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 541659020 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 859001 . This is a "MAILHANDLERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 097290 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55883 . This is a "OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110075685 . This is a "MC RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541659020 . This is a "VHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4299917 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541659020 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541659020 . This is a "UHC" identifier . This identifiers is of the category "OTHER".




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