Provider Demographics
NPI:1902172844
Name:HART, PATRICK WILLIAM JR (OMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WILLIAM
Last Name:HART
Suffix:JR
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FIFTH AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2238
Mailing Address - Country:US
Mailing Address - Phone:304-634-9700
Mailing Address - Fax:
Practice Address - Street 1:1000 FIFTH AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2238
Practice Address - Country:US
Practice Address - Phone:304-634-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6560998101YP1600X
DCAC500027171100000X
WVWV-96161171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral