Provider Demographics
NPI:1053404699
Name:HILDEBRAND, HARTWELL Z (MD)
Entity type:Individual
Prefix:
First Name:HARTWELL
Middle Name:Z
Last Name:HILDEBRAND
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 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:704-543-6636
Mailing Address - Fax:704-541-9476
Practice Address - Street 1:7810 PROVIDENCE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2954
Practice Address - Country:US
Practice Address - Phone:704-543-6636
Practice Address - Fax:704-541-9476
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC40958Medicaid
NC1053404699Medicaid
NC89134HRMedicaid
NCNC3465CMedicare UPIN
NCNC3465DMedicare UPIN
NCNC3465AMedicare PIN
NC2060769DMedicare PIN
NC89134HRMedicaid
NC2060769FMedicare PIN
NC2060769Medicare PIN
NCB92096Medicare UPIN
NC1053404699Medicaid
SCB920967772Medicare PIN
NCNC3465FMedicare PIN
NC2060769CMedicare PIN
SCAA59187772Medicare PIN
SCB920969092Medicare PIN
NCNC3465GMedicare PIN
NC2060769BMedicare PIN
NCNC3465BMedicare PIN
NCNC3465EMedicare PIN
NC2060769EMedicare PIN
NC2060769AMedicare PIN