Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 159314 | NY |
NPI | 1255544763 |
---|---|
Provider Name | Dr. Brian Hart |
First Address | Saranac Lake, NY 12983-5644 |
Second Address | Saranac Lake, NY 12983-5644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 28/12/2010 |