Provider Demographics
NPI:1851386452
Name:HARTMAN, MICHAEL T (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN525414163W00000X
PA072990367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50044077OtherCAPITAL ADVANTAGE
PA2001185OtherKHP CENTRAL
PA90781OtherGEISINGER
PA9668458OtherAETNA
PA1543042OtherGATEWAY
PA1027806560001Medicaid
PA1675571OtherFIRST PRIORITY
PA11803105OtherCAQH
PA1675571OtherHIGHMARK
PA2350211000OtherINDEP. BLUE CROSS
PA1675571OtherHIGHMARK
PAP00232975Medicare PIN
PA2350211000OtherINDEP. BLUE CROSS