Provider Demographics
NPI:1659157683
Name:HART, PHILIP CHARLES SR
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:CHARLES
Last Name:HART
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:WV
Mailing Address - Zip Code:25162-0410
Mailing Address - Country:US
Mailing Address - Phone:681-341-0372
Mailing Address - Fax:
Practice Address - Street 1:214 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4615
Practice Address - Country:US
Practice Address - Phone:304-917-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist