Provider Demographics
NPI:1336328384
Name:DONNA J HAGBERG, MD., LLC
Entity Type:Organization
Organization Name:DONNA J HAGBERG, MD., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAGBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-869-8353
Mailing Address - Street 1:1 PERRYRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4607
Mailing Address - Country:US
Mailing Address - Phone:203-869-8353
Mailing Address - Fax:203-869-4004
Practice Address - Street 1:1 PERRYRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4607
Practice Address - Country:US
Practice Address - Phone:203-869-8353
Practice Address - Fax:203-869-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty