Basic Information
Provider Information
NPI: 1003002783
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARTMAN
FirstName: MATTHEW
MiddleName: SCOTT
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3705 5TH AVE
Address2: CHP MT 3950
City: PITTSBURGH
State: PA
PostalCode: 152132584
CountryCode: US
TelephoneNumber: 4126476575
FaxNumber: 4128028221
Practice Location
Address1: 3705 5TH AVE
Address2: CHP MT 3950
City: PITTSBURGH
State: PA
PostalCode: 152132584
CountryCode: US
TelephoneNumber: 4126476575
FaxNumber: 4128028221
Other Information
ProviderEnumerationDate: 09/17/2007
LastUpdateDate: 11/15/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XMD432844PAY Other Service ProvidersSpecialist 
2085R0202X053750GAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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