Provider Demographics
NPI:1801988647
Name:HART, TIMOTHY J (DPM)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:HART
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 1:301 MENDON ROAD
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895
Mailing Address - Country:US
Mailing Address - Phone:401-769-5011
Mailing Address - Fax:401-769-2125
Practice Address - Street 1:1376 BRONCOS HWY RTE 102
Practice Address - Street 2:
Practice Address - City:BURRILLVILLE
Practice Address - State:RI
Practice Address - Zip Code:02858
Practice Address - Country:US
Practice Address - Phone:401-568-9980
Practice Address - Fax:401-769-2125
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2162213E00000X
RIDPM00222213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITH00848Medicaid
T53727Medicare UPIN