Provider Demographics
NPI:1235155110
Name:HART, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 KIMEL PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6973
Practice Address - Country:US
Practice Address - Phone:336-765-6637
Practice Address - Fax:336-765-6964
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084642207T00000X
NC2015-01818207T00000X
IN01086467A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000343715OtherANTHEM
OH000000523187OtherANTHEM
OH363616OtherWELLCARE MEDICAID
OHP00412341OtherRAILROAD MEDICARE
OH745364OtherBUCKEYE MEDICAID
OH7710574OtherAETNA
OH000000221397OtherUNISON
OH2501448Medicaid
OHP00192443OtherRAILROAD MEDICARE
OH745364OtherBUCKEYE MEDICAID
OH7710574OtherAETNA
OHHA4139421Medicare PIN