Provider Demographics
NPI:1164461935
Name:HARTE, EDITH H (MD OBGYN)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:H
Last Name:HARTE
Suffix:
Gender:F
Credentials:MD OBGYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WEST SUPERIOR ST.
Mailing Address - Street 2:ERIE FAMILY HEALTH CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5646
Mailing Address - Country:US
Mailing Address - Phone:312-432-7392
Mailing Address - Fax:312-666-6228
Practice Address - Street 1:1701 W SUPERIOR ST
Practice Address - Street 2:ERIE FAMILY HEALTH CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5646
Practice Address - Country:US
Practice Address - Phone:312-432-7392
Practice Address - Fax:312-666-6228
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079857H207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2280295Medicaid
HA4062932Medicare ID - Type Unspecified
OH2280295Medicaid