Provider Demographics
NPI:1063416816
Name:HARTJEN, CHARLES A (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:HARTJEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W MACPHAIL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4309
Mailing Address - Country:US
Mailing Address - Phone:443-643-2082
Mailing Address - Fax:443-643-2088
Practice Address - Street 1:615 W MACPHAIL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4309
Practice Address - Country:US
Practice Address - Phone:443-643-2082
Practice Address - Fax:443-643-2088
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33378207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1619038510OtherNPI TYPE II
MD1053594010OtherNPI TYPE LL
MD407041100Medicaid
MD3615682OtherAETNA HMO
MD4330577OtherAETNA PPO
MD0285376014OtherCIGNA
MDJ7980001OtherBLUE CHOICE/FEDERAL BCBS
MD523068OtherMAMSI
MD839AOtherCAREFIRST BCBS
MD5492660001Medicare NSC
MD3615682OtherAETNA HMO
MD4330577OtherAETNA PPO
D76741Medicare UPIN
D76741Medicare UPIN