Provider Demographics
NPI:1518013838
Name:HARTZ, LEO MITRI (MD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:MITRI
Last Name:HARTZ
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 1:218 HILLSIDE TWO
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1848
Mailing Address - Country:US
Mailing Address - Phone:570-674-8927
Mailing Address - Fax:570-674-4988
Practice Address - Street 1:218 HILLSIDE TWO
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1848
Practice Address - Country:US
Practice Address - Phone:570-674-8927
Practice Address - Fax:570-674-4988
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016554E207Q00000X
FLME81767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine