1952302697 NPI number — ELAINE DESROSIERS HART NP

Table of content: ELAINE DESROSIERS HART NP (NPI 1952302697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952302697 NPI number — ELAINE DESROSIERS HART NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HART
Provider First Name:
ELAINE
Provider Middle Name:
DESROSIERS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952302697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1180 HOPE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02809-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-247-0610
Provider Business Mailing Address Fax Number:
401-245-7362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
286 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRINGTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02806-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-247-0610
Provider Business Practice Location Address Fax Number:
401-245-7362
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN 16786 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 697704 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: AD00546 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000030891 . This is a "B/S" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 406137 . This is a "TUFTS HEALTH PLANS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 04-00518 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 405673 . This is a "BCHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 3862 . This is a "NEIGHBORHOOH HEALTH PLANS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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