Provider Demographics
NPI:1689624207
Name:HART, MELINDA BETH (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:BETH
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:195 CENTER RD
Practice Address - Street 2:UNIT B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-492-6227
Practice Address - Fax:941-492-6335
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0049467208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01808766OtherCLEAR HEALTH ALLIANCE
FL5018201OtherAETNA
FL10556OtherBCBS FL
FL2307432OtherCIGNA
FLP01023430OtherRAILROAD MCR
FLP100894OtherFREEDOM HEALTH
FL279265OtherAVMED
FL1173811OtherWELLCARE
FLP938318OtherOPTIMUM
FL1173811OtherWELLCARE
FL5018201OtherAETNA
FLP100894OtherFREEDOM HEALTH