Provider Demographics
NPI:1114951555
Name:HARTMANN, DIANE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:HARTMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 668
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-0638
Mailing Address - Fax:585-273-3359
Practice Address - Street 1:500 RED CREEK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4284
Practice Address - Country:US
Practice Address - Phone:585-487-3420
Practice Address - Fax:585-334-1264
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176004207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01280648Medicaid
NYP010176004OtherBLUE CHOICE
NYMDA340OtherPREFERRED CARE
NY3442OtherBLUE SHIELD
NY7194201OtherAETNA
NYJ400046224Medicare PIN
NY01280648Medicaid
NY7194201OtherAETNA