Provider Demographics
NPI:1902854979
Name:HART, MARILYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:M
Last Name:HART
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5055 E BROADWAY BLVD STE A-100
Mailing Address - Street 2:ARIZONA COMMUNITY PHYSICIANS PC
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:5880 N LA CHOLLA BLVD STE 150
Practice Address - Street 2:CASAS ADOBES FAMILY PRACTICE
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-751-3602
Practice Address - Fax:520-547-5761
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-05-08
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Provider Licenses
StateLicense IDTaxonomies
AZ16155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D36991Medicare UPIN