Provider Information for 1275953804
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ANGELA HART
Sex: Female
NPI: 1275953804
Last Updated: 2022-09-20
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1275953804 | ||||||||||||||
| Enumeration Date | 2014-04-22 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 263 FARMINGTON AVE FARMINGTON, CT 06032-1956 United States Phone: | Fax: | ||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE GENERAL MEDICINE CLINIC-MC2811 FARMINGTON, CT 06032-1956 United States Phone: 860-679-4477 | Fax:860-679-1025 | ||||||||||||||
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