Provider Demographics
NPI:1790775575
Name:HARTMAN, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
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 1:6000 N BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-5102
Mailing Address - Country:US
Mailing Address - Phone:716-834-4266
Mailing Address - Fax:716-834-6255
Practice Address - Street 1:6000 N BAILEY AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-5102
Practice Address - Country:US
Practice Address - Phone:716-834-4266
Practice Address - Fax:716-834-6255
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0409832OtherIHA
NY000510500004OtherBC/BS
NY01091661Medicaid
NY145446BJOtherPREFERRED CARE
NY00010073603OtherUNIVERA
NY040426002696OtherFIDELIS
NY145446BJOtherPREFERRED CARE
NY0409832OtherIHA