Provider Demographics
NPI:1437156684
Name:HARTMAN, MARY E (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:HARTMAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5401 NORRIS CANYON RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5409
Mailing Address - Country:US
Mailing Address - Phone:925-277-1132
Mailing Address - Fax:925-277-1225
Practice Address - Street 1:5401 NORRIS CANYON RD
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5409
Practice Address - Country:US
Practice Address - Phone:925-277-1132
Practice Address - Fax:925-277-1225
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG45846207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE24942Medicare UPIN