Provider Demographics
NPI:1225006711
Name:SCULLIN-HARTMAN, KRISTEN ANN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:SCULLIN-HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:SCULLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4921 PARKVIEW PL # 5G
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-747-1970
Mailing Address - Fax:314-747-1972
Practice Address - Street 1:4921 PARKVIEW PL STE 5G
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-1970
Practice Address - Fax:314-747-1972
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110229387OtherRAILROAD MEDICARE
MO967275280Medicare PIN
F71583Medicare UPIN