Basic Information
Provider Information
NPI: 1063831774
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HART
FirstName: LAURA
MiddleName: MARGARITA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 401 11TH ST NE
Address2:  
City: SPRINGHILL
State: LA
PostalCode: 710754503
CountryCode: US
TelephoneNumber: 3185391701
FaxNumber: 3185391733
Practice Location
Address1: 401 11TH ST NE
Address2:  
City: SPRINGHILL
State: LA
PostalCode: 71075
CountryCode: US
TelephoneNumber: 3185391701
FaxNumber: 3185395688
Other Information
ProviderEnumerationDate: 04/09/2014
LastUpdateDate: 05/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X305578LAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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