Provider Demographics
NPI:1578788659
Name:WARTMAN, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WARTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 MAIN ST
Mailing Address - Street 2:STE. # 5
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1142
Mailing Address - Country:US
Mailing Address - Phone:413-733-9600
Mailing Address - Fax:413-732-6534
Practice Address - Street 1:3455 MAIN ST
Practice Address - Street 2:STE. # 5
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1142
Practice Address - Country:US
Practice Address - Phone:413-733-9600
Practice Address - Fax:413-732-6534
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242901207N00000X
NH14398207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA892633OtherCONNECTICARE
MA49282OtherHNE
MA7048969OtherCIGNA
MA753392OtherTUFTS
MA892633OtherCONNECTICARE