Provider Demographics
NPI:1538179478
Name:HARTMAN, ALAN B (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 CHESTER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1919
Mailing Address - Country:US
Mailing Address - Phone:765-935-4088
Mailing Address - Fax:765-966-2596
Practice Address - Street 1:1471 CHESTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1919
Practice Address - Country:US
Practice Address - Phone:765-935-4088
Practice Address - Fax:765-966-2596
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100352350AMedicaid
IN000000108617OtherBLUE SHIELD - REID HOSP
IN903830MMedicare ID - Type UnspecifiedREID HOSPITAL - EKG
IN100352350AMedicaid
IN903630CMedicare PIN
INM400023738Medicare PIN
IN110136682Medicare Oscar/Certification