Provider Demographics
NPI:1215189725
Name:HAROLD J. HETTLEMAN, M.D., P.A.
Entity type:Organization
Organization Name:HAROLD J. HETTLEMAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BLARGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-832-5511
Mailing Address - Street 1:5 PARK CENTER CT
Mailing Address - Street 2:SUITE 14
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4201
Mailing Address - Country:US
Mailing Address - Phone:410-356-2935
Mailing Address - Fax:
Practice Address - Street 1:5 PARK CENTER CT
Practice Address - Street 2:SUITE 14
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4201
Practice Address - Country:US
Practice Address - Phone:410-356-2935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0005004207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B70019Medicare UPIN
MD165RMedicare PIN