Provider Demographics
NPI:1851324883
Name:MARY E. HARTMAN, M.D., INC.
Entity Type:Organization
Organization Name:MARY E. HARTMAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-277-1132
Mailing Address - Street 1:5401 NORRIS CANYON RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5409
Mailing Address - Country:US
Mailing Address - Phone:925-277-1132
Mailing Address - Fax:925-277-1225
Practice Address - Street 1:5401 NORRIS CANYON RD
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5409
Practice Address - Country:US
Practice Address - Phone:925-277-1132
Practice Address - Fax:925-277-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45846207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437156684OtherTYPE 1 NPI
CA1437156684OtherTYPE 1 NPI