Provider Demographics
NPI:1104959832
Name:DECESARE, JOSEPH A (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:DECESARE
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 1:201 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00240213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0137515002OtherCIGNA
RI2343OtherNEIGHBORHOOD HEALTH
RI2700150OtherUNITED HEALTHCARE OF NEW
RI400515OtherBLUECHIP OF RI
RI0000007071OtherBLUE CROSS OF RI
RI050456966OtherWPS TRICARE
RI0000007071OtherBLUECHIP GROUP
RI001868OtherTUFTS
RI050456966OtherUNITED HEALTHCARE
RI1006490001OtherNHIC, CORP. DME MAC
RI7001766Medicaid
RIR003457OtherWPS TRICARE
RI0000000007071OtherBLUE CROSS FEP
RI0005779230OtherAETNA
RI050456966OtherCIGNA
RI782937OtherAETNA
RIZE5188OtherBLUE CROSS OF MA
RI0000000007071OtherBLUE CROSS FEP
RI1006490001OtherNHIC, CORP. DME MAC