Provider Demographics
NPI:1720177413
Name:TIMOTHY J & DENNIS J HART DPM PC
Entity Type:Organization
Organization Name:TIMOTHY J & DENNIS J HART DPM PC
Other - Org Name:TJ & DJ HART DPM PC
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
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:401-769-5001
Mailing Address - Street 1:301 MENDON ROAD
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-2496
Mailing Address - Country:US
Mailing Address - Phone:401-769-5011
Mailing Address - Fax:401-769-2125
Practice Address - Street 1:301 MENDON ROAD
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-2496
Practice Address - Country:US
Practice Address - Phone:401-769-5011
Practice Address - Fax:401-769-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI700981Medicaid