Provider Demographics
NPI:1194846154
Name:FEDERAL HILL PODIATRY GROUP
Entity Type:Organization
Organization Name:FEDERAL HILL PODIATRY GROUP
Other - Org Name:JOSEPH A DECESARE DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DECESARE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-421-9167
Mailing Address - Street 1:201 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3015
Mailing Address - Country:US
Mailing Address - Phone:401-421-9167
Mailing Address - Fax:401-421-9193
Practice Address - Street 1:201 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3015
Practice Address - Country:US
Practice Address - Phone:401-421-9167
Practice Address - Fax:401-421-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00240213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2343OtherNEIGHBORHOOD J A DECESARE
RI400515OtherBLUECHIP J A DECESARE DP
RI0000007071OtherBCBS RI GROUP ID
RIR003457OtherWPS TRICARE GROUP ID
RI0005779230OtherAETNA
RI0137515002OtherCIGNA
RI0000007071OtherBLUECHIP GROUP ID
RI0357OtherNEIGHBORHOOD GROUP ID
RIFH00185Medicaid
RIZE5188OtherBCBS MA GROUP ID
RI1006490001Medicare NSC
RIZE5188OtherBCBS MA GROUP ID