Provider Demographics
NPI:1336680784
Name:DAVID A HART MD PC
Entity Type:Organization
Organization Name:DAVID A HART MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-738-2911
Mailing Address - Street 1:1300 NW HARRISON BLVD
Mailing Address - Street 2:SUITE B-10
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6277
Mailing Address - Country:US
Mailing Address - Phone:541-738-2911
Mailing Address - Fax:541-738-2738
Practice Address - Street 1:1300 NW HARRISON BLVD
Practice Address - Street 2:SUITE B-10
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6277
Practice Address - Country:US
Practice Address - Phone:541-738-2911
Practice Address - Fax:541-738-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19540261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health