Healthcare Provider Details

I. General information

NPI: 1861481160
Provider Name (Legal Business Name): JENNIFER R HARTMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 N. MAIN ST. FAMILY MEDICAL & MATERNITY CARE, PC
LEOMINSTER MA
01453
US

IV. Provider business mailing address

87 N. MAIN ST. FAMILY MEDICAL & MATERNITY CARE, PC
LEOMINSTER MA
01453
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-8701
  • Fax: 978-534-8705
Mailing address:
  • Phone: 978-534-8701
  • Fax: 978-534-8705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number238361
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: