Provider Demographics
NPI:1114059466
Name:HAGEDORN ASSOC PC
Entity Type:Organization
Organization Name:HAGEDORN ASSOC PC
Other - Org Name:DRS TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-747-4541
Mailing Address - Street 1:240 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062
Mailing Address - Country:US
Mailing Address - Phone:860-747-4541
Mailing Address - Fax:860-793-1218
Practice Address - Street 1:240 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062
Practice Address - Country:US
Practice Address - Phone:860-747-4541
Practice Address - Fax:860-793-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCO1397Medicare ID - Type Unspecified