1619038510 NPI number — HARTJEN SPINE CARE, P.A.

Table of content: (NPI 1619038510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619038510 NPI number — HARTJEN SPINE CARE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARTJEN SPINE CARE, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1619038510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6565 N CHARLES ST
Provider Second Line Business Mailing Address:
SUITE 416
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-6800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-830-2290
Provider Business Mailing Address Fax Number:
410-830-2293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6565 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 416
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-830-2290
Provider Business Practice Location Address Fax Number:
410-830-2293
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARTJEN
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-830-2290

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D33378 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0285376014 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 523068 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3615682 . This is a "AETNO HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4330577 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1053594010 . This is a "NPI TYPE II" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1063416816 . This is a "NPI TYPE I NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J7980001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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