Provider Demographics
NPI:1184643421
Name:HARTIGAN, JOSEPH (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:HARTIGAN
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 1:317 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6817
Mailing Address - Country:US
Mailing Address - Phone:617-522-5464
Mailing Address - Fax:617-524-2966
Practice Address - Street 1:317 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6817
Practice Address - Country:US
Practice Address - Phone:617-522-5464
Practice Address - Fax:617-524-2966
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1606213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70718OtherBCBS
MA701445OtherTUFTS
MA344354Medicaid
MA344354Medicaid
MA701445OtherTUFTS