Provider Demographics
NPI:1619087350
Name:HART, STEPHEN M (MD PA)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:HART
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PA
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:6606 LYNDON B JOHNSON FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-233-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4386207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0047EDOtherBCBS
00G645OtherBCBS
E83473Medicare UPIN