MEDICARE: ELZIE F. HART, JR. 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	207YX0602X	Otolaryngic Allergy Physician	15490	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	2309468	OTHER	NC	MEDICARE GROUP #

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	40177	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1912007493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELZIE F. HART, JR. MD PA

Provider Business Mailing Address
First Line	:	PO BOX 340
Second Line	:
City	:	MORGANTON
State	:	NC
Zip	:	28680-0340
Country	:	US
Telephone Number	:	828-433-6410
Fax Number	:	828-438-4779

Provider Business Practice Location Address
First Line	:	350 E PARKER RD
Second Line	:
City	:	MORGANTON
State	:	NC
Zip	:	28655-5155
Country	:	US
Telephone Number	:	828-433-6410
Fax Number	:	828-438-4779

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELZIE FRANKLIN HART JR.
Credential	:	M.D.
Telephone Number	:	828-433-6410

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	08/01/2007

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