Provider Demographics
NPI:1114136298
Name:HART, EILEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:M
Last Name:HART
Suffix:
Gender:M
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:C STREET E 10
Mailing Address - Street 2:URB SANTA MARTA
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0000
Mailing Address - Country:US
Mailing Address - Phone:787-264-7934
Mailing Address - Fax:787-264-7929
Practice Address - Street 1:C STREET E 10
Practice Address - Street 2:URB SANTA MARTA
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0000
Practice Address - Country:US
Practice Address - Phone:787-264-7934
Practice Address - Fax:787-264-7929
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF63411Medicare UPIN