Healthcare Provider Details

I. General information

NPI: 1609294271
Provider Name (Legal Business Name): BENJAMIN RANDALL HART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 HOSPITAL DR STE 1620
TOLEDO OH
43614-8001
US

IV. Provider business mailing address

3000 ARLINGTON AVE STOP 1108
TOLEDO OH
43614-2595
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-6105
  • Fax: 419-383-2874
Mailing address:
  • Phone: 419-383-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301104782
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301118734
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.138576
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: