Individual
NOUSHIN IZADIFAR HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2776 ENTERPRISE RD, SUITE 100, ORANGE CITY, FL 32763-8316
(386) 774-1223
(386) 774-1507
Mailing address
2776 ENTERPRISE RD, SUITE 100, ORANGE CITY, FL 32763-8316
(386) 774-1223
(386) 774-1507
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
0101248816
VA
2085R0001X
Radiation Oncology Physician
036101984
IL
2085R0001X
Radiation Oncology Physician
L5385
TX
2085R0001X
Radiation Oncology Physician
Primary
ME112142
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00250T
GROUP MEDICARE PIN
TX
01
—
00251T
GROUP MEDICARE PIN
TX
01
—
8B1190
MEDICARE PTAN
TX
Enumeration date
07/28/2005
Last updated
07/05/2012
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