MEDICARE: TIMOTHY B. HART, MD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	013NC	OTHER	NC	BCBS GROUP NUMBER
3	D352	OTHER	NC	PARTNERS GROUP NUMBER

General Provider Information

NPI Number	:	1578656542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY B. HART, MD, PA

Provider Business Mailing Address
First Line	:	123 SUNNYBROOK RD
Second Line	:	SUITE 140
City	:	RALEIGH
State	:	NC
Zip	:	27610-2783
Country	:	US
Telephone Number	:	919-250-0580
Fax Number	:	919-250-9939

Provider Business Practice Location Address
First Line	:	123 SUNNYBROOK RD
Second Line	:	SUITE 140
City	:	RALEIGH
State	:	NC
Zip	:	27610-2783
Country	:	US
Telephone Number	:	919-250-0580
Fax Number	:	919-250-9939

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHARON S. HART
Credential	:
Telephone Number	:	919-250-0580

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/29/2009

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