Healthcare Provider Details

I. General information

NPI: 1235439738
Provider Name (Legal Business Name): CAROLYN M. HARTMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 WILLAMETTE ST SUITE 307-A
EUGENE OR
97401-2952
US

IV. Provider business mailing address

767 WILLAMETTE ST SUITE 307-A
EUGENE OR
97401-2952
US

V. Phone/Fax

Practice location:
  • Phone: 541-653-9168
  • Fax:
Mailing address:
  • Phone: 541-653-9168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD20511
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. CAROLYN M. HARTMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 541-653-9168