Basic Information
| Provider Information | |||||||||
| NPI: | 1417375791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARTOG | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | ROELOFS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CHILDRENS PL | ||||||||
| Address2: | MSC 8515-87-1200 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144546095 | ||||||||
| FaxNumber: | 3144542561 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PL | ||||||||
| Address2: | DIV PED CARDIOLOGY | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144546095 | ||||||||
| FaxNumber: | 3144542561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2014 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2021018955 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0002X | 2021018955 | MO | N | 207RC0000X | 2021018955 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 208000000X | 2021018955 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | 2021018955 | MO | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
No ID Information.