Provider Demographics
NPI:1275527509
Name:HART, RAYMOND GERALD (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:GERALD
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 1:225 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:STE 700
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1846
Mailing Address - Country:US
Mailing Address - Phone:502-561-4263
Mailing Address - Fax:502-561-4221
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:STE 700
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-561-4263
Practice Address - Fax:502-561-4221
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
KY25652207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC68409Medicare UPIN