Provider Demographics
NPI:1013231232
Name:HARTGE, TERA ANNE (CSA)
Entity Type:Individual
Prefix:MRS
First Name:TERA
Middle Name:ANNE
Last Name:HARTGE
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:TERA
Other - Middle Name:ANNE
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSA
Mailing Address - Street 1:510 SHELVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-7008
Mailing Address - Country:US
Mailing Address - Phone:330-843-2597
Mailing Address - Fax:
Practice Address - Street 1:510 SHELVIEW CIR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-7008
Practice Address - Country:US
Practice Address - Phone:330-843-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical