Individual
MR. THOMAS MARK HARTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4444 MAGNOLIA AVE, RIVERSIDE, CA 92501
(951) 682-5661
(951) 686-3758
Mailing address
4444 MAGNOLIA AVE, RIVERSIDE, CA 92501-4136
(951) 682-5661
(951) 686-3758
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
100628
MO
207X00000X
Orthopaedic Surgery Physician
Primary
G89301
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093058
UNITED HEALTH CARE
—
01
—
1164407391
COVENTRY
—
01
—
18475026
BCBS
—
01
—
3076318
CIGNA
—
01
—
4364771
AETNA
—
01
—
P00455132
RAILROAD MEDICARE
—
Enumeration date
12/09/2005
Last updated
07/13/2018
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