Provider Demographics
NPI:1366439127
Name:HART, VANESSA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:MARIE
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FACS
Mailing Address - Street 1:6443 BUSINESS PARK LOOP RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-6272
Mailing Address - Country:US
Mailing Address - Phone:435-901-4334
Mailing Address - Fax:
Practice Address - Street 1:6443 BUSINESS PARK LOOP RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-6272
Practice Address - Country:US
Practice Address - Phone:435-200-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7355233-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267795400Medicaid
FL267795400Medicaid
FLG00200Medicare UPIN