Provider Demographics
NPI:1750025193
Name:HART, JARED F (MILITARY (IDC))
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:F
Last Name:HART
Suffix:
Gender:M
Credentials:MILITARY (IDC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2514
Mailing Address - Country:US
Mailing Address - Phone:267-980-1192
Mailing Address - Fax:
Practice Address - Street 1:SUBMARINE READINESS SQUADRON 32
Practice Address - Street 2:BUILDING 87 NAVAL SUBMARINE BASE NEW LONDON
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349
Practice Address - Country:US
Practice Address - Phone:860-649-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman