Provider Demographics
NPI:1275023020
Name:HARTWICK, SALLY (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:HARTWICK
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 1:25 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:NY
Mailing Address - Zip Code:13730-2129
Mailing Address - Country:US
Mailing Address - Phone:607-639-2701
Mailing Address - Fax:607-639-3333
Practice Address - Street 1:25 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730-2129
Practice Address - Country:US
Practice Address - Phone:607-639-2701
Practice Address - Fax:607-639-3333
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308696-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine