Provider Demographics
NPI:1255302816
Name:HARTMARK, MARTINA E (MD)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:E
Last Name:HARTMARK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5463
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:2500 COMO AVE
Practice Address - Street 2:MAIL STOP 31100A
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1460
Practice Address - Country:US
Practice Address - Phone:651-641-6200
Practice Address - Fax:651-641-3121
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN31147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10253Medicare UPIN