MEDICARE: DAVID LARRY HARTZELL 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	207W00000X	Ophthalmology Physician	MDO1O154E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366455727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LARRY HARTZELL M.D.

Provider Business Mailing Address
First Line	:	37 BROOKWOOD AVE
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17015
Country	:	US
Telephone Number	:	717-243-8606
Fax Number	:	717-243-7221

Provider Business Practice Location Address
First Line	:	37 BROOKWOOD AVE
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-9126
Country	:	US
Telephone Number	:	717-243-8606
Fax Number	:	717-243-7221

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/21/2022

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