Provider Demographics
NPI:1336213503
Name:HARTLEY, ALVANUS HOWLAND (MD)
Entity Type:Individual
Prefix:
First Name:ALVANUS
Middle Name:HOWLAND
Last Name:HARTLEY
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 1:995 PRINCE FREDERICK BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3198
Mailing Address - Country:US
Mailing Address - Phone:410-535-5855
Mailing Address - Fax:410-535-6574
Practice Address - Street 1:995 PRINCE FREDERICK BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3198
Practice Address - Country:US
Practice Address - Phone:410-535-5855
Practice Address - Fax:410-535-6574
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038429207N00000X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02349Medicare UPIN
479L398CMedicare ID - Type Unspecified