Provider Demographics
NPI:1396832333
Name:HARSHBARGER-KELLY, MARTHA E (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:HARSHBARGER-KELLY
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 1:16100 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:OH
Mailing Address - Zip Code:44065-9104
Mailing Address - Country:US
Mailing Address - Phone:440-564-9408
Mailing Address - Fax:
Practice Address - Street 1:3973 LOOMIS PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-1803
Practice Address - Country:US
Practice Address - Phone:330-296-2819
Practice Address - Fax:330-296-9503
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-075827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2243763Medicaid
OH2243763Medicaid
HA4044171Medicare ID - Type Unspecified