Provider Demographics
NPI:1306830252
Name:HARTSUCH, TOM A (MD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:A
Last Name:HARTSUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12502 WILLOWBROOK RD
Mailing Address - Street 2:SUITE 660
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6491
Mailing Address - Country:US
Mailing Address - Phone:240-964-8760
Mailing Address - Fax:240-964-8769
Practice Address - Street 1:12502 WILLOWBROOK RD
Practice Address - Street 2:SUITE 660
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6491
Practice Address - Country:US
Practice Address - Phone:240-964-8760
Practice Address - Fax:240-964-8769
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0056074207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0056074OtherSTATE LICENSE
MD233044076OtherTAX ID
MDD0056074OtherSTATE LICENSE
MD937L448EMedicare PIN