Provider Demographics
NPI:1821004672
Name:HARTWELL, PATRICIA W (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:W
Last Name:HARTWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 PEACH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560-1805
Mailing Address - Country:US
Mailing Address - Phone:914-669-5801
Mailing Address - Fax:
Practice Address - Street 1:844 PEACH LAKE RD
Practice Address - Street 2:
Practice Address - City:NORTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10560-1805
Practice Address - Country:US
Practice Address - Phone:914-669-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116138207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00214911Medicaid
NYB20589Medicare UPIN
NY00214911Medicaid