MEDICARE: DR. LYUDMILA VASILIEVNA HARTT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	TEMPORARY	TX
2	2084P0804X	Child & Adolescent Psychiatry Physician	TEMPORARY	TX

General Provider Information

NPI Number	:	1083713192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYUDMILA VASILIEVNA HARTT M.D.

Provider Business Mailing Address
First Line	:	19026 STONE OAK PKWY
Second Line	:	205
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3227
Country	:	US
Telephone Number	:	210-495-4085
Fax Number	:	210-495-4086

Provider Business Practice Location Address
First Line	:	19026 STONE OAK PKWY
Second Line	:	205
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3227
Country	:	US
Telephone Number	:	210-495-4085
Fax Number	:	210-495-4086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	11/20/2009

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