Provider Demographics
NPI:1417000829
Name:HART, PAUL BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BRIAN
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 1:159 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1876
Mailing Address - Country:US
Mailing Address - Phone:716-639-0567
Mailing Address - Fax:
Practice Address - Street 1:533 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-1810
Practice Address - Country:US
Practice Address - Phone:716-743-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186744-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000523958002OtherBLUE CROSS
NY3007674OtherINDEPENDENT HEALTH
NY00020008602OtherUNIVERA
NY00020008602OtherUNIVERA