Provider Demographics
NPI:1164406419
Name:HART, GEOFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:A
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:P.O. BOX 372
Mailing Address - Street 2:C/O MA ANESTHESIA CORP
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-0372
Mailing Address - Country:US
Mailing Address - Phone:781-341-3966
Mailing Address - Fax:508-798-8012
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:C/O MA ANESTHESIA CORP
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:781-341-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157809207L00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A51345Medicare UPIN
MAA34297Medicare ID - Type Unspecified