Provider Demographics
NPI:1114933611
Name:HACKER, RICHARD (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HACKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1484
Mailing Address - Country:US
Mailing Address - Phone:508-947-5355
Mailing Address - Fax:508-256-8586
Practice Address - Street 1:154 W GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1484
Practice Address - Country:US
Practice Address - Phone:508-947-5355
Practice Address - Fax:508-256-8586
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1740213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
33040OtherHARVARD PILGRIM
MA0362387Medicaid
33396OtherHARVARD PILGRIM
709822OtherTUFTS
33040OtherHARVARD PILGRIM
T58759Medicare UPIN
YY7129Medicare ID - Type Unspecified