Provider Demographics
NPI:1013979962
Name:HART, OLIVER JAMES III (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:JAMES
Last Name:HART
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-277-1717
Mailing Address - Fax:336-277-1718
Practice Address - Street 1:2010 BALDWIN LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5846
Practice Address - Country:US
Practice Address - Phone:336-277-1717
Practice Address - Fax:336-277-1718
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33527208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40253OtherBCBS ID
NC8940253Medicaid
NCP00457721OtherRAILROAD MEDICARE
NCP00457721OtherRAILROAD MEDICARE
NC8940253Medicaid
NC340014Medicare Oscar/Certification
NC40253OtherBCBS ID
NC2141994DMedicare PIN