Provider Demographics
NPI:1982942850
Name:HARTMANN, TERRANCE LARRY (PA-C)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:LARRY
Last Name:HARTMANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 E. RIDGEVILLE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771
Mailing Address - Country:US
Mailing Address - Phone:301-829-5906
Mailing Address - Fax:301-829-5909
Practice Address - Street 1:504 E. RIDGEVILLE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771
Practice Address - Country:US
Practice Address - Phone:301-829-5906
Practice Address - Fax:301-829-5909
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006710363A00000X, 363AM0700X
MDC0006362363AM0700X
MDC06362363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical