Provider Demographics
NPI:1275501488
Name:HARTUNG, BETH ANN (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:HARTUNG
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 1:1100 TRANCAS ST 300
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2921
Mailing Address - Country:US
Mailing Address - Phone:707-492-9236
Mailing Address - Fax:425-949-5377
Practice Address - Street 1:1141 PEAR TREE LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-254-1774
Practice Address - Fax:707-251-2993
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A671880Medicaid
CA110246653Medicare PIN
H22401Medicare UPIN
00A671881Medicare PIN