Provider Demographics
NPI:1780635854
Name:HARTZHEIM, THOMAS S (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:HARTZHEIM
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 1:739 IRVING AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1651
Mailing Address - Country:US
Mailing Address - Phone:315-470-7364
Mailing Address - Fax:315-470-5859
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1651
Practice Address - Country:US
Practice Address - Phone:315-470-7364
Practice Address - Fax:315-470-5859
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181994208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01442662Medicaid
F48832Medicare UPIN
56409FMedicare ID - Type Unspecified
020033142Medicare PIN