Provider Demographics
NPI:1518006360
Name:HARTMANN, PETER A (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:HARTMANN
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 1:21 HIGHLAND AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3872
Mailing Address - Country:US
Mailing Address - Phone:978-463-8686
Mailing Address - Fax:978-499-8514
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-463-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA071021208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3048314Medicaid
MA071024OtherTUFTS
MAJ08287OtherBLUE COSS BLUE SHIELF
MAD88555Medicare UPIN
MAJ08287Medicare ID - Type Unspecified