Provider Demographics
NPI: | 1922008283 |
---|---|
Name: | HARTMAN, RICHARD S (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | RICHARD |
Middle Name: | S |
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: | 5221 US ROUTE 60 |
Mailing Address - Street 2: | |
Mailing Address - City: | HUNTINGTON |
Mailing Address - State: | WV |
Mailing Address - Zip Code: | 25705-2022 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 304-552-1550 |
Mailing Address - Fax: | 304-522-1073 |
Practice Address - Street 1: | 989 MEDICAL PARK DR |
Practice Address - Street 2: | |
Practice Address - City: | MAYSVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 41056-8750 |
Practice Address - Country: | US |
Practice Address - Phone: | 606-759-3130 |
Practice Address - Fax: | 502-227-5081 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-28 |
Last Update Date: | 2023-08-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 28095 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 000000058821 | Other | ANTHEM BC PIN |
KY | 8759011 | Other | UNITED HEALTHCARE PIN |
KY | G24321 | Other | BLUEGRASS FAMILY HEALTH |
KY | 64280951 | Medicaid | |
KY | G24321 | Other | BLUEGRASS FAMILY HEALTH |