Healthcare Provider Details

I. General information

NPI: 1194846154
Provider Name (Legal Business Name): FEDERAL HILL PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BROADWAY
PROVIDENCE RI
02903-3015
US

IV. Provider business mailing address

201 BROADWAY
PROVIDENCE RI
02903-3015
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-9167
  • Fax: 401-421-9193
Mailing address:
  • Phone: 401-421-9167
  • Fax: 401-421-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM00240
License Number StateRI

VIII. Authorized Official

Name: DR. JOSEPH A DECESARE
Title or Position: OWNER
Credential: DPM
Phone: 401-421-9167