Provider Demographics
NPI:1972742609
Name:HART, CHRISTINE R (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:R
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:R
Other - Last Name:BUCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:308 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-2104
Mailing Address - Country:US
Mailing Address - Phone:303-870-5419
Mailing Address - Fax:
Practice Address - Street 1:308 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-2104
Practice Address - Country:US
Practice Address - Phone:303-870-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2167207Q00000X
CO41911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDD25200Medicare UPIN