Provider Demographics
NPI:1558339101
Name:HARTMAN, LAWRENCE P (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:HARTMAN
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 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-392-9300
Mailing Address - Fax:423-392-9365
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 4A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-392-9300
Practice Address - Fax:423-392-9365
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36815207T00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5803430001OtherDME NUMBER
TN9454636OtherCIGNA
TN3877574Medicaid
VA177324OtherANTHEM BCBS VA INDV
KY64059660Medicaid
TN4103830OtherBCBS TN
TN4205736OtherAETNA
TNP00221383OtherRR MEDICARE
TN9454636OtherCIGNA
TN5803430001OtherDME NUMBER