Provider Demographics
NPI:1639653454
Name:HART, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 SPENCER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OH
Mailing Address - Zip Code:44275-9798
Mailing Address - Country:US
Mailing Address - Phone:216-409-8680
Mailing Address - Fax:
Practice Address - Street 1:4302 ALLEN RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1070
Practice Address - Country:US
Practice Address - Phone:330-865-4644
Practice Address - Fax:330-865-4641
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator