Healthcare Provider Details

I. General information

NPI: 1043319254
Provider Name (Legal Business Name): JOSEPH HARTOG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 DWIGHT WAY SUITE 101
BERKELEY CA
94704
US

IV. Provider business mailing address

PO BOX 29210
SAN FRANCISCO CA
94129-0210
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-8700
  • Fax: 510-848-8778
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG6861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: