Provider Demographics
NPI:1124099627
Name:HART, EDWIN S III (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:S
Last Name:HART
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2305 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-5009
Mailing Address - Country:US
Mailing Address - Phone:610-868-4300
Mailing Address - Fax:610-691-7624
Practice Address - Street 1:2305 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-5009
Practice Address - Country:US
Practice Address - Phone:610-868-4300
Practice Address - Fax:610-691-7624
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC002595L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28739Medicare UPIN
PA108566Medicare PIN