Provider Demographics
NPI:1134226798
Name:HARTWIG, RANDALL J (DO)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:J
Last Name:HARTWIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 CENTERVALE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4522
Mailing Address - Country:US
Mailing Address - Phone:330-965-0298
Mailing Address - Fax:
Practice Address - Street 1:6426 MARKET ST
Practice Address - Street 2:WORKMED
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-3434
Practice Address - Country:US
Practice Address - Phone:330-884-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine