Healthcare Provider Details

I. General information

NPI: 1669798534
Provider Name (Legal Business Name): JACOB CAMERON HARTZ MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD STE 500
CHARLOTTE NC
28203-5863
US

IV. Provider business mailing address

1001 BLYTHE BLVD STE 500
CHARLOTTE NC
28203-5863
US

V. Phone/Fax

Practice location:
  • Phone: 704-373-1813
  • Fax: 704-342-5871
Mailing address:
  • Phone: 704-373-1813
  • Fax: 704-342-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number165196
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: