Provider Demographics
NPI:1497721930
Name:HART, ELIZABETH B (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
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 1:15 STRAWBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5941
Mailing Address - Country:US
Mailing Address - Phone:207-777-7740
Mailing Address - Fax:207-795-9342
Practice Address - Street 1:15 STRAWBERRY AVE
Practice Address - Street 2:ANDROSCOGGIN HOME CARE & HOSPICE
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5941
Practice Address - Country:US
Practice Address - Phone:207-777-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013508207QG0300X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME311490099Medicaid
ME311490099Medicaid
MEUX3258Medicare PIN
MEF53853Medicare UPIN
MEP00163693Medicare PIN
MEUX3258Medicare PIN