Provider Demographics
NPI:1942409461
Name:HART, JESSE LUKE (DO)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LUKE
Last Name:HART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:117 ELLENFIELD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:APC 12
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5151
Practice Address - Fax:401-444-8514
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIDO00766207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU400163795Medicare PIN
RIU400163791Medicare PIN