Provider Demographics
NPI:1376556050
Name:HARTLE, RICHARD J (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:HARTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:5424 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2862
Practice Address - Country:US
Practice Address - Phone:757-206-1190
Practice Address - Fax:757-208-0601
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049148207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
541659020OtherPHCS
859001OtherMAILHANDLERS
097290OtherANTHEM
55883OtherOPTIMA
110075685OtherMC RAILROAD
541659020OtherVHN
4299917OtherAETNA
541659020OtherCIGNA
541659020OtherUHC
097290OtherANTHEM
4299917OtherAETNA