Provider Demographics
NPI:1578656542
Name:TIMOTHY B. HART, MD, PA
Entity Type:Organization
Organization Name:TIMOTHY B. HART, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-250-0580
Mailing Address - Street 1:123 SUNNYBROOK RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-2783
Mailing Address - Country:US
Mailing Address - Phone:919-250-0580
Mailing Address - Fax:919-250-9939
Practice Address - Street 1:123 SUNNYBROOK RD
Practice Address - Street 2:SUITE 140
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2783
Practice Address - Country:US
Practice Address - Phone:919-250-0580
Practice Address - Fax:919-250-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013NCMedicaid
NC013NCOtherBCBS GROUP NUMBER
NCD352OtherPARTNERS GROUP NUMBER
NC=========OtherTAX ID NUMBER
NC89013NCMedicaid