Provider Demographics
NPI:1720051519
Name:HART, CLAUDIA D (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:D
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE STE 375
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3476
Mailing Address - Country:US
Mailing Address - Phone:602-277-4161
Mailing Address - Fax:
Practice Address - Street 1:300 W. CLARENDON AVE. #375
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3476
Practice Address - Country:US
Practice Address - Phone:602-277-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062568L174400000X
AZ402882080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001679901Medicaid
AZ328651Medicaid
PA004715EACMedicare ID - Type Unspecified
PA001679901Medicaid