Provider Demographics
NPI:1962498287
Name:HART, MARILYN J (MD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-5400
Mailing Address - Fax:802-225-5401
Practice Address - Street 1:195 HOSPITAL LOOP
Practice Address - Street 2:SUITE 3
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9522
Practice Address - Country:US
Practice Address - Phone:802-225-5400
Practice Address - Fax:802-225-5401
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT5580207R00000X
VT0420005580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004631Medicaid
VT0420005580OtherLICENSE
VTHAVT4631Medicare ID - Type Unspecified
VT0004631Medicaid
VT463101Medicare PIN