Provider Demographics
NPI:1760475727
Name:HARTLEY, BRENDA M (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:M
Other - Last Name:HARTLEY-DYMARKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5700 MONROE ST UNIT 301
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2737
Mailing Address - Country:US
Mailing Address - Phone:419-291-2121
Mailing Address - Fax:419-479-6017
Practice Address - Street 1:5700 MONROE ST UNIT 301
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2737
Practice Address - Country:US
Practice Address - Phone:419-291-2121
Practice Address - Fax:419-479-6017
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000141209OtherANTHEM
MI3505802301OtherBCBS MI
OH370012698OtherRRMC
OH10717OtherHPM
OH0997711OtherBCMH
OH12-01238OtherUHC
OH01872OtherPHC
OH0997711Medicaid
MI12-03667OtherUHC
MI4530886OtherAETNA
OH0637659OtherAETNA
MI000000217929OtherANTHEM
OH10717OtherHPM
OH370012698OtherRRMC