Provider Demographics
NPI:1558336388
Name:HARTLEY, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HARTLEY
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 1:874 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6232
Mailing Address - Country:US
Mailing Address - Phone:508-992-6553
Mailing Address - Fax:508-990-7558
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-992-6553
Practice Address - Fax:508-990-7558
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57416207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0466461-002OtherCIGNA PAL
MA3053890Medicaid
MA27750OtherCHILDREN'SMEDICALSECURITY
MA436718OtherHARVARD PILGRIM
MA754110OtherTUFTS HEALTH PLAN
MA96108101OtherNETWORK HEALTH
MA0017722OtherNHP
MA26379-3OtherBCBSRI
MAB10360401OtherCIGNA
MA000000024027OtherBMC HEALTHNET
MA004705OtherSENIOR WHOLE HEALTH
MA2978827OtherAETNA
MA409720OtherBCBSBLUECHIP
MAF21010OtherBCBSMA
MA004705OtherSENIOR WHOLE HEALTH
MA409720OtherBCBSBLUECHIP