Provider Demographics
NPI:1104008184
Name:WILLIAM HARTIGAN JR. DPM
Entity Type:Organization
Organization Name:WILLIAM HARTIGAN JR. DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:617-387-1999
Mailing Address - Street 1:563 BROADWAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:563 BROADWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3749
Practice Address - Country:US
Practice Address - Phone:617-387-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0564090001Medicare NSC