Provider Demographics
NPI:1902892284
Name:HART, EDWARD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAMES
Last Name:HART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:57 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2141
Mailing Address - Country:US
Mailing Address - Phone:978-354-2795
Mailing Address - Fax:978-740-4748
Practice Address - Street 1:57 HIGHLAND AVE
Practice Address - Street 2:NEUROLOGY
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2141
Practice Address - Country:US
Practice Address - Phone:978-354-2795
Practice Address - Fax:978-740-4748
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA29497204D00000X, 2080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Not Answered2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0504265OtherUNITED PBO
MA029497OtherTUFTS
MAB98626MGHOtherHPHC-ACD
MAM)8640OtherBCBS
MA5181477OtherAETNA
MA2017164Medicaid
MAB98626003MGHOtherHPHC-PBO
MAM)8640OtherBCBS
MA0504265OtherUNITED PBO