MEDICARE: DR. TOM A HARTSUCH 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	207VG0400X	Gynecology Physician	D0056074	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D0056074	OTHER	MD	STATE LICENSE
2	233044076	OTHER	MD	TAX ID

General Provider Information

NPI Number	:	1306830252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOM A HARTSUCH M.D.

Provider Business Mailing Address
First Line	:	12502 WILLOWBROOK RD
Second Line	:	SUITE 660
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-6491
Country	:	US
Telephone Number	:	240-964-8760
Fax Number	:	240-964-8769

Provider Business Practice Location Address
First Line	:	12502 WILLOWBROOK RD
Second Line	:	SUITE 660
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-6491
Country	:	US
Telephone Number	:	240-964-8760
Fax Number	:	240-964-8769

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	08/11/2015

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Directions to “ DR. TOM A HARTSUCH M.D.” Practice Location

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