Provider Demographics
NPI:1649423906
Name:HARTSOCK, LORNE BENJAMIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LORNE
Middle Name:BENJAMIN
Last Name:HARTSOCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 BRIDGEWATER LN
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4106
Mailing Address - Country:US
Mailing Address - Phone:423-246-0033
Mailing Address - Fax:423-245-0034
Practice Address - Street 1:130 RAVINE RD
Practice Address - Street 2:HOLSTON VALLEY MEDICAL CENTER C/O NETEP
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-224-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant