Provider Demographics
NPI:1144317421
Name:HARTMAN, IRA FRANKLIN (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:FRANKLIN
Last Name:HARTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:I.
Other - Middle Name:F
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:CENTRAL WV MEDCORP, INC.
Mailing Address - Street 2:P.O. BOX 2630
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2630
Mailing Address - Country:US
Mailing Address - Phone:304-637-3799
Mailing Address - Fax:304-637-3369
Practice Address - Street 1:11 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2231
Practice Address - Country:US
Practice Address - Phone:304-472-1600
Practice Address - Fax:304-472-6382
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09346207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV09346BOtherHEALTH PLAN
WV0127478000Medicaid
WVHA4021832Medicare PIN
WVWV09346BOtherHEALTH PLAN