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General NPI Number Information
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NPI Number | 1023043056
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Entity Type | Individual
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Provider Name | SUSAN H HART M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 09/06/2025
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Provider Practice Location Address
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Address Line | 110 ELMWOOD AVE
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City | PROVIDENCE
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State | RI
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Zip | 02907-2423
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Country | US
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Telephone | 401-275-5039
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Fax |
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Provider Business Mailing Address
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Address Line | 393 MONTGOMERY AVE
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City | PROVIDENCE
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State | RI
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Zip | 02905-1326
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Country | US
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Telephone | 401-300-5757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | MD10734
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD10734
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License Number State | RI
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