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General NPI Number Information
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NPI Number | 1699775866
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Entity Type | Individual
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Provider Name | NOUSHIN IZADIFAR HART MD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 2776 ENTERPRISE RD SUITE 100
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City | ORANGE CITY
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State | FL
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Zip | 32763-8316
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Country | US
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Telephone | 386-774-1223
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Fax | 386-774-1507
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Provider Business Mailing Address
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Address Line | 2776 ENTERPRISE RD SUITE 100
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City | ORANGE CITY
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State | FL
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Zip | 32763-8316
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Country | US
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Telephone | 386-774-1223
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Fax | 386-774-1507
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | L5385
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 036101984
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 0101248816
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME112142
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License Number State | FL
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