Provider Demographics
NPI:1699864389
Name:HART, DENNIS J (DPM)
Entity type:Individual
Prefix:
First Name:DENNIS
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 1:301 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00203213E00000X
RIDPM203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7000982Medicaid
RIDH71889Medicaid
RIDH71889Medicaid
RI007060468Medicare UPIN
007000982Medicare ID - Type Unspecified