Provider Demographics
NPI:1558504118
Name:HARTMAN, HEATHER N (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:HARTMAN
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 1:10495 MONTGOMERY RD STE 24
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4420
Mailing Address - Country:US
Mailing Address - Phone:513-791-6006
Mailing Address - Fax:513-791-3399
Practice Address - Street 1:10495 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4468
Practice Address - Country:US
Practice Address - Phone:513-791-6006
Practice Address - Fax:513-791-3399
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098960207K00000X
WI60169207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168263Medicaid
OH0168263Medicaid