MEDICARE: DR. JASON NOEL HARTIS 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	207P00000X	Emergency Medicine Physician	25MA08997200	NJ
2	207P00000X	Emergency Medicine Physician	C157802	CA

General Provider Information

NPI Number	:	1467615633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON NOEL HARTIS MD

Provider Business Mailing Address
First Line	:	4006 STIRRUP CT
Second Line	:
City	:	UPPER CHICHESTER
State	:	PA
Zip	:	19061-2642
Country	:	US
Telephone Number	:	215-796-2322
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 STIRRUP CT
Second Line	:
City	:	UPPER CHICHESTER
State	:	PA
Zip	:	19061-2642
Country	:	US
Telephone Number	:	215-796-2322
Fax Number	:

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	03/13/2024

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