Doctor Name: | PHILLIP MATTHEW HARTLE |
NPI Number: | 1891948220 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MT189010 |
Business Practice Address: | 3400 S Crater Rd Suite B Petersburg, VA - 238059252 |
Business Phone Number: | 8047336960 |
Business Fax Number: | 8047333880 |
Mailing Address: | 3400 S Crater Rd, Suite B PETERSBURG |
State: | VA |
Postal Code: | 238059252 |
Phone Number: | 8047336960 |
Fax Number: | 8047333880 |
NPI Enumeration Date: | 10/29/2008 |
NPI Last Update Date: | 06/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | MT189010 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |