MEDICARE: RICHARD J HARTLE 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	207RG0100X	Gastroenterology Physician	0101049148	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	541659020	OTHER	PHCS
2	859001	OTHER	MAILHANDLERS
3	097290	OTHER	ANTHEM
4	55883	OTHER	OPTIMA
5	110075685	OTHER	MC RAILROAD
6	541659020	OTHER	VHN
7	4299917	OTHER	AETNA
8	541659020	OTHER	CIGNA
9	541659020	OTHER	UHC

General Provider Information

NPI Number	:	1376556050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J HARTLE MD

Provider Business Mailing Address
First Line	:	860 OMNI BLVD
Second Line	:	SUITE 303
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4430
Country	:	US
Telephone Number	:	757-232-8769
Fax Number	:	757-232-8875

Provider Business Practice Location Address
First Line	:	5424 DISCOVERY PARK BLVD
Second Line	:	SUITE 104
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-2862
Country	:	US
Telephone Number	:	757-206-1190
Fax Number	:	757-208-0601

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/06/2019

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