Provider Demographics
NPI:1568620169
Name:TIMOTHY J HART, DPM, PC
Entity Type:Organization
Organization Name:TIMOTHY J HART, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-568-9980
Mailing Address - Street 1:1376 BRONCOS HWY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02858-1000
Mailing Address - Country:US
Mailing Address - Phone:401-568-9980
Mailing Address - Fax:401-568-7472
Practice Address - Street 1:1376 BRONCOS HWY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:RI
Practice Address - Zip Code:02858-1000
Practice Address - Country:US
Practice Address - Phone:401-568-9980
Practice Address - Fax:401-568-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6192060001Medicare NSC