Healthcare Provider Details

I. General information

NPI: 1003043472
Provider Name (Legal Business Name): MELISSA K HARTMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 N MONROE DR
XENIA OH
45385-1619
US

IV. Provider business mailing address

1141 N MONROE DR
XENIA OH
45385-1619
US

V. Phone/Fax

Practice location:
  • Phone: 937-352-2685
  • Fax: 937-352-3685
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number35093282
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: