Healthcare Provider Details

I. General information

NPI: 1417938986
Provider Name (Legal Business Name): WILLIAM O HARTZELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date: 02/04/2019
Reactivation Date: 02/18/2019

III. Provider practice location address

150 FLANDERS RD
WESTBOROUGH MA
01581-1017
US

IV. Provider business mailing address

PO BOX 62 TURNPIKE STATION
SHREWSBURY MA
01545-0062
US

V. Phone/Fax

Practice location:
  • Phone: 508-871-2000
  • Fax:
Mailing address:
  • Phone: 508-334-8815
  • Fax: 508-334-5374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101239857
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: