Provider Demographics
NPI:1992768600
Name:HATLEBERG, STEVEN LUDDEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:LUDDEN
Last Name:HATLEBERG
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 1:11110 MEDICAL CAMPUS RD 150
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6755
Mailing Address - Country:US
Mailing Address - Phone:240-313-9850
Mailing Address - Fax:240-313-9851
Practice Address - Street 1:13424 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2658
Practice Address - Country:US
Practice Address - Phone:240-313-9850
Practice Address - Fax:240-313-9851
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403490200Medicaid
MDB40836Medicare UPIN
MD053MH693Medicare ID - Type Unspecified