Provider Demographics
NPI:1366414757
Name:HART, MARY C (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:HART
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1810 MACKENZIE DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2967
Mailing Address - Country:US
Mailing Address - Phone:614-273-2234
Mailing Address - Fax:614-273-2255
Practice Address - Street 1:555 S 18TH ST
Practice Address - Street 2:SUITE 6B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2654
Practice Address - Country:US
Practice Address - Phone:614-221-6789
Practice Address - Fax:614-221-8323
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-08-18
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Provider Licenses
StateLicense IDTaxonomies
OH35054428H207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0699374Medicaid
H07161Medicare UPIN
0895179Medicare ID - Type Unspecified