Provider Demographics
NPI:1407898844
Name:DIMITROVA HART, MARIANA G (MD)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:G
Last Name:DIMITROVA HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:G
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14870 GRANADA AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5514
Mailing Address - Country:US
Mailing Address - Phone:952-432-3223
Mailing Address - Fax:
Practice Address - Street 1:14870 GRANADA AVE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5514
Practice Address - Country:US
Practice Address - Phone:952-432-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46344OtherMN LICENSE
MN46344OtherMN LICENSE