Provider Demographics
NPI:1891948220
Name:HARTLE, PHILLIP MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MATTHEW
Last Name:HARTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:671 HIOAKS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4072
Mailing Address - Country:US
Mailing Address - Phone:804-272-5814
Mailing Address - Fax:804-560-0232
Practice Address - Street 1:7001 W BROAD ST
Practice Address - Street 2:STE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-3701
Practice Address - Country:US
Practice Address - Phone:804-673-2722
Practice Address - Fax:804-282-5723
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2016-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101254122207RN0300X
PAMT189010390200000X
PAMD436849207R00000X
TN48848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine