Healthcare Provider Details

I. General information

NPI: 1235716309
Provider Name (Legal Business Name): MICHAEL JAMES HARTNETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 EAST ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 EAST ADAMS ST
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5450
  • Fax: 315-464-6322
Mailing address:
  • Phone: 315-464-5450
  • Fax: 315-464-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number339198-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number339198-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: