Provider Demographics
NPI:1033138383
Name:HAGGAG, ED (PAC)
Entity Type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:HAGGAG
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BIRDSEYE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2489
Mailing Address - Country:US
Mailing Address - Phone:203-215-4403
Mailing Address - Fax:
Practice Address - Street 1:10 BIRDSEYE RD STE 260
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2489
Practice Address - Country:US
Practice Address - Phone:203-518-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19953363AM0700X
CT4932363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU98506Medicare UPIN