Provider Demographics
NPI:1528163466
Name:HARTZELL, SCOTT M (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:HARTZELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:137 JPM RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9313
Mailing Address - Country:US
Mailing Address - Phone:570-523-3937
Mailing Address - Fax:
Practice Address - Street 1:137 JPM RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9313
Practice Address - Country:US
Practice Address - Phone:570-523-3937
Practice Address - Fax:570-524-5279
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051651L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001432510Medicaid
0171379OtherCAPITAL BLUE
194425OtherBLUE CROSS
6206OtherGEISINGER
194425OtherBLUE CROSS