Provider Demographics
NPI:1629019815
Name:HARTMAN, EDWIN L (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:L
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 1:388 I VENTURE DR.
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3841
Mailing Address - Country:US
Mailing Address - Phone:919-915-3987
Mailing Address - Fax:919-989-7349
Practice Address - Street 1:388 I VENTURE DR.
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3841
Practice Address - Country:US
Practice Address - Phone:919-915-3987
Practice Address - Fax:919-989-7349
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891176CMedicaid
NC891176CMedicaid