Provider Demographics
NPI:1912007493
Name:ELZIE F. HART, JR. MD PA
Entity Type:Organization
Organization Name:ELZIE F. HART, JR. MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELZIE
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:HART
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:828-433-6410
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28680-0340
Mailing Address - Country:US
Mailing Address - Phone:828-433-6410
Mailing Address - Fax:828-438-4779
Practice Address - Street 1:350 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5155
Practice Address - Country:US
Practice Address - Phone:828-433-6410
Practice Address - Fax:828-438-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-24
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15490207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8940177Medicaid
NC40177OtherBCBSNC
NC2309468OtherMEDICARE GROUP #
NC201470AMedicare PIN
NC40177OtherBCBSNC