Provider Demographics
NPI:1053594010
Name:HARTJEN SPINE CARE, P.A.
Entity type:Organization
Organization Name:HARTJEN SPINE CARE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTJEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-683-7260
Mailing Address - Street 1:1 TEXAS STATION CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-8286
Mailing Address - Country:US
Mailing Address - Phone:410-683-7260
Mailing Address - Fax:410-683-3492
Practice Address - Street 1:7300 VAN DUSEN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9463
Practice Address - Country:US
Practice Address - Phone:410-683-7260
Practice Address - Fax:410-683-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33378174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1619038510OtherNPI TYPE LL
MD1063416816OtherNPI TYPE 1
MD1063416816OtherNPI TYPE 1
MDD76741Medicare UPIN
MD047NMedicare PIN