Provider Demographics
NPI:1114937539
Name:HARTWIG, C. DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:C. DEAN
Middle Name:
Last Name:HARTWIG
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 1:1961 LAS PLUMAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1741
Mailing Address - Country:US
Mailing Address - Phone:408-251-9300
Mailing Address - Fax:408-251-9400
Practice Address - Street 1:1961 LAS PLUMAS AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1741
Practice Address - Country:US
Practice Address - Phone:408-251-9300
Practice Address - Fax:408-251-9400
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC327842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ80499ZMedicare ID - Type Unspecified