Cornelis Dehart Jr., MD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

MD00046608 Issued in WA

Practice address

3436 Mary Elder Rd NE
Olympia, WA 98506-5050

Phone

(360) 528-2590

NPI assigned

Oct 19, 2006

Last updated

Dec 3, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bridgeways

  • Community/Behavioral Health Agency
  • Everett, WA
  • NPI 1073589560
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228262400000",
    "number": "1760564934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3857 MARTIN WAY E",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065268",
            "telephone_number": "360-704-7170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3436 MARY ELDER RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065050",
            "telephone_number": "360-528-2590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEHART",
        "first_name": "CORNELIS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2008-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "MD00046608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Decremer, DPT
• John Deffenbaugh
• Henry L Degive, MD
• Stephanie Muyargas Degroff
• Eliza Deguzman, PHARMD
• David Michael Deitz, MD
• Andrew Dejesus, CNIM
• Carmella L Dejesus
• Kimberly Marie Delaney
• Jean Gant Delastrada, M.ED., M.A.

• Psychologist in Olympia, WA
• Providers in Olympia, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.