Provider Demographics
NPI:1447506944
Name:HARTMAN, MARY L (LAC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:M
Other - Middle Name:LUE
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:106 JOHN BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8103
Mailing Address - Country:US
Mailing Address - Phone:301-455-0941
Mailing Address - Fax:
Practice Address - Street 1:9881 BROKEN LAND PKWY
Practice Address - Street 2:WOODMERE I, SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1172
Practice Address - Country:US
Practice Address - Phone:240-841-2639
Practice Address - Fax:240-841-2644
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist