Provider Demographics
NPI:1912981663
Name:HARTMAN, ELIZABETH MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7799 LEESBURG PIKE
Mailing Address - Street 2:SUITE 1000 N
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2408
Mailing Address - Country:US
Mailing Address - Phone:703-667-8600
Mailing Address - Fax:703-667-8601
Practice Address - Street 1:3301 NEW MEXICO AVE NW
Practice Address - Street 2:SUITE 106
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3622
Practice Address - Country:US
Practice Address - Phone:703-442-4714
Practice Address - Fax:703-442-4715
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0357842085R0202X
MDD00619062085R0202X
VA01012387512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
016785W30OtherUNSPECIFIED
470001526OtherRR MEDICARE
MD575P177HMedicare PIN
I09624Medicare UPIN
470001526OtherRR MEDICARE
DC016785W30Medicare PIN
016785W30OtherUNSPECIFIED