1851386452 NPI number — MICHAEL T HARTMAN CRNA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851386452 NPI number — MICHAEL T HARTMAN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTMAN
Provider First Name:
MICHAEL
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1851386452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 S CEDAR CREST BLVD
Provider Second Line Business Mailing Address:
SUITE #301
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18103-6258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-402-9099
Provider Business Mailing Address Fax Number:
610-402-9029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-402-9099
Provider Business Practice Location Address Fax Number:
610-402-9029
Provider Enumeration Date:
09/20/2005

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: 163W00000X , with the licence number:  RN525414 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 072990 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50044077 . This is a "CAPITAL ADVANTAGE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2001185 . This is a "KHP CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 90781 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 9668458 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1543042 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1027806560001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1675571 . This is a "FIRST PRIORITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 11803105 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1675571 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2350211000 . This is a "INDEP. BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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