Healthcare Provider Details

I. General information

NPI: 1619942232
Provider Name (Legal Business Name): CARL WILLIAM HARTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 KINGSBOROUGH SQ SUITE 100
CHESAPEAKE VA
23320-5041
US

IV. Provider business mailing address

5700 CLEVELAND ST SUITE 228
VIRGINIA BEACH VA
23462-1752
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9294
  • Fax: 757-548-0092
Mailing address:
  • Phone: 757-499-2825
  • Fax: 757-499-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101026391
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: