Provider Demographics
NPI:1316950413
Name:HARTLING, ROSS P (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:P
Last Name:HARTLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6725
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-0725
Mailing Address - Country:US
Mailing Address - Phone:425-649-7540
Mailing Address - Fax:425-649-7548
Practice Address - Street 1:330 S. STILLLAGUAMISH AVENUE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:425-649-7540
Practice Address - Fax:425-649-7548
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD002429312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8144081Medicaid
WAA06352Medicare UPIN
WA8865592Medicare PIN