Provider Demographics
NPI:1598726903
Name:HART, THOMAS MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MITCHELL
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 1:1508 MACON DR
Mailing Address - Street 2:SUITE C-6
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1867
Mailing Address - Country:US
Mailing Address - Phone:501-224-7246
Mailing Address - Fax:501-221-3958
Practice Address - Street 1:1508 MACON DR
Practice Address - Street 2:SUITE C-6
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1867
Practice Address - Country:US
Practice Address - Phone:501-224-7246
Practice Address - Fax:501-221-3958
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4114174400000X
ARR4114208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE67036Medicare UPIN
AR53709Medicare ID - Type Unspecified