Provider Demographics
NPI:1366455727
Name:HARTZELL, DAVID LARRY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LARRY
Last Name:HARTZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015
Mailing Address - Country:US
Mailing Address - Phone:717-243-8606
Mailing Address - Fax:717-243-7221
Practice Address - Street 1:37 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-9126
Practice Address - Country:US
Practice Address - Phone:717-243-8606
Practice Address - Fax:717-243-7221
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMDO1O154E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005964010003Medicaid
PA0005964010003Medicaid
PA023381Medicare ID - Type Unspecified