Healthcare Provider Details

I. General information

NPI: 1801922646
Provider Name (Legal Business Name): HUNT VALLEY FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10155 YORK RD STE 200
COCKEYSVILLE MD
21030-3336
US

IV. Provider business mailing address

10155 YORK RD STE 200
COCKEYSVILLE MD
21030-3336
US

V. Phone/Fax

Practice location:
  • Phone: 410-628-2026
  • Fax: 410-667-6834
Mailing address:
  • Phone: 410-628-2026
  • Fax: 410-667-6834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0026575
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD71533
License Number StateMD

VIII. Authorized Official

Name: DAVID J HARTIG
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 410-628-2026