Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 2005-01185 | NC |
NPI | 1184606147 |
---|---|
Provider Name | Dr. Joel Michael Hartman |
First Address | Skyland, NC 28776-2207 |
Second Address | Winston Salem, NC 27103-2932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 18/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140RV | BCBS (01) | NC |
199210 | MEDCOST (01) | NC |
5901212 | (05) | NC |
7716786 | AETNA (01) | NC |
806731 | PARTNERS (01) | NC |
I34893 | (02) | |
NC0853B | MEDICARE PTAN (01) | NC |