Provider Demographics
NPI:1265439814
Name:HARTZELL, MARYANN P (DPM)
Entity type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:P
Last Name:HARTZELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22433
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2433
Mailing Address - Country:US
Mailing Address - Phone:215-777-5801
Mailing Address - Fax:215-777-5716
Practice Address - Street 1:148 N 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2418
Practice Address - Country:US
Practice Address - Phone:215-777-5808
Practice Address - Fax:215-777-5825
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC0036191213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA710559OtherHIGHMARK
PA50040438OtherCAPTIAL BLUE CROSS
PAU28081Medicare UPIN
PA710559OtherHIGHMARK