Basic Information
| Provider Information | |||||||||
| NPI: | 1831118231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 S BROAD ST | ||||||||
| Address2: | 1ST FLOOR, METHODIST HOSPITAL | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191483542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159529136 | ||||||||
| FaxNumber: | 2159529138 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 S BROAD ST | ||||||||
| Address2: | 1ST FLOOR, METHODIST HOSPITAL | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191483542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159529136 | ||||||||
| FaxNumber: | 2159529138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 09/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD-027871-E | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | MD-027871-E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7333501 | 05 | NJ | MEDICAID | 001013854 | 05 | PA | MEDICAID |