1912996463 NPI number — DR. MARY MARGARET HART PH.D.

Table of content: DR. MARY MARGARET HART PH.D. (NPI 1912996463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912996463 NPI number — DR. MARY MARGARET HART PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HART
Provider First Name:
MARY
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912996463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2703 VALLEY VIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEFONTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16823-8852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-355-5595
Provider Business Mailing Address Fax Number:
814-353-9722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2703 VALLEY VIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEFONTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16823-8852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-355-5595
Provider Business Practice Location Address Fax Number:
814-353-9722
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  PS004804L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109552 . This is a "VALUEOPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01116802 . This is a "CAPITAL BLUE CROSS (CAIC)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 461353 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: D61353 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101758285 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2057018 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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