MEDICARE: KRISTIN MG HARTT MD

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	207Q00000X	Family Medicine Physician	MD26053	OR
2	207Q00000X	Family Medicine Physician	MD17450	ME

General Provider Information

NPI Number	:	1275587131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MG HARTT MD

Provider Business Mailing Address
First Line	:	194 E MAIN ST
Second Line	:	FORT KENT
City	:	FORT KENT
State	:	ME
Zip	:	04743-1428
Country	:	US
Telephone Number	:	207-834-3155
Fax Number	:	207-834-2949

Provider Business Practice Location Address
First Line	:	194 E MAIN ST
Second Line	:	FORT KENT
City	:	FORT KENT
State	:	ME
Zip	:	04743-1428
Country	:	US
Telephone Number	:	207-834-3155
Fax Number	:	207-834-2949

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/20/2007

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