Provider Demographics
NPI:1619038510
Name:HARTJEN SPINE CARE, P.A.
Entity Type:Organization
Organization Name:HARTJEN SPINE CARE, P.A.
Other - Org Name:GREATER BALTIMORE SPINE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTJEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-830-2290
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:SUITE 416
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-830-2290
Mailing Address - Fax:410-830-2293
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 416
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-830-2290
Practice Address - Fax:410-830-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33378174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0285376014OtherCIGNA
MD523068OtherMAMSI
MD3615682OtherAETNO HMO
MD4330577OtherAETNA PPO
MD1053594010OtherNPI TYPE II
MD1063416816OtherNPI TYPE I NUMBER
MDJ7980001OtherCAREFIRST BCBS
MD1053594010OtherNPI TYPE II
MD1063416816OtherNPI TYPE I NUMBER
MD5492660001Medicare NSC