Provider Demographics
NPI:1831204668
Name:HARTING, MARLONA KAY (DO)
Entity type:Individual
Prefix:DR
First Name:MARLONA
Middle Name:KAY
Last Name:HARTING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-5257
Mailing Address - Country:US
Mailing Address - Phone:260-458-2641
Mailing Address - Fax:
Practice Address - Street 1:1717 S CALHOUN ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-5257
Practice Address - Country:US
Practice Address - Phone:260-458-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002211A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7584345OtherAETNA
IN000000595576OtherANTHEM
IN200231200AMedicaid
INP00698436OtherRAILROAD MEDICARE
IN259060AMedicare PIN
IN7584345OtherAETNA
INH25669Medicare UPIN