Healthcare Provider Details

I. General information

NPI: 1093704637
Provider Name (Legal Business Name): ANNE-RENNE HARTMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-1591
  • Fax: 510-204-6440
Mailing address:
  • Phone: 510-204-1591
  • Fax: 510-204-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA651021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: