Provider Demographics
NPI:1033164264
Name:HART, CYNTHIA H (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:H
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 S HURSTBOURNE PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5757
Mailing Address - Country:US
Mailing Address - Phone:502-583-2731
Mailing Address - Fax:502-583-2733
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-587-4231
Practice Address - Fax:502-583-2733
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY294332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000517555OtherANTHEM BCBS
KY2842802000OtherPASSPORT ADVANTAGE
KYP00453566OtherRAILROAD MEDICARE
KY50014792OtherPASSPORT
KY64002082Medicaid
KY4724841OtherCIGNA
KY2842802000OtherPASSPORT ADVANTAGE
KY00011019Medicare PIN
KY50014792OtherPASSPORT