Provider Demographics
NPI:1952366486
Name:HART, DAVID ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLEN
Last Name:HART
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41008
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-1008
Mailing Address - Country:US
Mailing Address - Phone:800-849-5609
Mailing Address - Fax:910-483-8921
Practice Address - Street 1:1110 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4523
Practice Address - Country:US
Practice Address - Phone:919-481-0277
Practice Address - Fax:919-481-9777
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952366486OtherNPI
NCP33297Medicare UPIN
1282880002Medicare NSC
2749037Medicare ID - Type Unspecified