Provider Demographics
NPI:1255333688
Name:HART, SHERN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERN
Middle Name:
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:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-0488
Mailing Address - Country:US
Mailing Address - Phone:607-387-5781
Mailing Address - Fax:
Practice Address - Street 1:47 HECTOR
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886
Practice Address - Country:US
Practice Address - Phone:607-387-5781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124668208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00463254Medicaid
NY00463254Medicaid
E 16832Medicare UPIN