Provider Demographics
NPI:1053301671
Name:HARTMAN, DAVID M (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1970
Mailing Address - Country:US
Mailing Address - Phone:330-364-5656
Mailing Address - Fax:330-602-8832
Practice Address - Street 1:335 OXFORD ST
Practice Address - Street 2:SUITE A
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1970
Practice Address - Country:US
Practice Address - Phone:330-602-8833
Practice Address - Fax:330-602-8832
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084120207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2489230Medicaid
OH4130661Medicare PIN
OH4130662Medicare PIN
OH2489230Medicaid