MEDICARE: DAVID L HARTZELL 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	207W00000X	Ophthalmology Physician	MD010154E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02534900	OTHER	PA	CAPITAL BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598987646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID L HARTZELL MD

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	:	17015-9126
Country	:	US
Telephone Number	:	717-243-8606
Fax Number	:	717-243-7221

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID LARRY HARTZELL
Credential	:	M.D.
Telephone Number	:	717-243-8606

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/22/2020

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