Basic Information
Provider Information | |||||||||
NPI: | 1508831967 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HART | ||||||||
FirstName: | PATRICIA | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 571 S ALLEN RD | ||||||||
Address2: |   | ||||||||
City: | FLAT ROCK | ||||||||
State: | NC | ||||||||
PostalCode: | 287319447 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286926178 | ||||||||
FaxNumber: | 8282330358 | ||||||||
Practice Location | |||||||||
Address1: | 571 S ALLEN RD | ||||||||
Address2: |   | ||||||||
City: | FLAT ROCK | ||||||||
State: | NC | ||||||||
PostalCode: | 28731 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286926178 | ||||||||
FaxNumber: | 8282330358 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/21/2006 | ||||||||
LastUpdateDate: | 08/22/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 2008-00034 | NC | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RH0002X | 2008-00034 | NC | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
ID | Type | State | Issuer | Description | 5912877 | 05 | NC |   | MEDICAID | 2008-00034 | 01 | NC | NEPHROLOGY | OTHER | FH1672840 | 01 | NC | DEA | OTHER | 2008-00034 | 01 | NC | INTERNAL MEDICINE | OTHER |