Provider Demographics
NPI:1992003966
Name:HART, ADAM D (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:HART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21315 NORTH SH 130 #B
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2678
Mailing Address - Country:US
Mailing Address - Phone:512-763-0869
Mailing Address - Fax:888-965-5316
Practice Address - Street 1:21315 NORTH SH 130 #B
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2678
Practice Address - Country:US
Practice Address - Phone:512-763-0869
Practice Address - Fax:844-823-8677
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3679207W00000X
IL01074275A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN204460003Medicare PIN