Provider Demographics
NPI:1205856564
Name:HARTMAN, SCOTT GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:GREGORY
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:55 BARRETT DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580
Mailing Address - Country:US
Mailing Address - Phone:585-758-0750
Mailing Address - Fax:585-872-0876
Practice Address - Street 1:55 BARRETT DR
Practice Address - Street 2:STE 100
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580
Practice Address - Country:US
Practice Address - Phone:585-758-0750
Practice Address - Fax:585-872-0876
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2476712084P0804X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03013747Medicaid