Provider Demographics
NPI:1548524457
Name:HARTMAN, PHILIP ANDREW (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ANDREW
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-491-2855
Mailing Address - Fax:859-655-4395
Practice Address - Street 1:5100 PEACE WAY
Practice Address - Street 2:
Practice Address - City:TAYLOR MILL
Practice Address - State:KY
Practice Address - Zip Code:41015-3506
Practice Address - Country:US
Practice Address - Phone:859-491-2855
Practice Address - Fax:859-655-4395
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100304340Medicaid
KYK145150Medicare PIN