Provider Demographics
NPI:1912932625
Name:HARTMAN, ALICE MARIE (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:MARIE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 CORPORATE WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274
Mailing Address - Country:US
Mailing Address - Phone:812-523-3112
Mailing Address - Fax:812-523-2069
Practice Address - Street 1:1407 CORPORATE WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274
Practice Address - Country:US
Practice Address - Phone:812-523-3112
Practice Address - Fax:812-523-2069
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042089A207V00000X
IN0104208919207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100407630Medicaid
INP00151305OtherMEDICARE RAILROAD
IN000000336964OtherBLUE CROSS BLUE SHIELD
IN0104208919Medicaid
IN044981OtherSOUTHEASTERN IN HEALTH OR
IN219680AMedicare ID - Type Unspecified