Provider Demographics
NPI:1629202866
Name:HARTMAN, HEIDI JON (DO)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JON
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 SUMMIT CROSSING PL STE 106
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2189
Mailing Address - Country:US
Mailing Address - Phone:704-867-8021
Mailing Address - Fax:
Practice Address - Street 1:620 SUMMIT CROSSING PL STE 106
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2189
Practice Address - Country:US
Practice Address - Phone:704-867-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-02
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-001502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology