Provider Demographics
NPI:1437364742
Name:HAGENBUCH, SEAN CARLTON (MD, FAAP, FACC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CARLTON
Last Name:HAGENBUCH
Suffix:
Gender:M
Credentials:MD, FAAP, FACC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:PEDIATRIC OP SPECIALTY CARE- CARDIOLOGY
Practice Address - Street 2:417 STATE ST WEBBER EAST #305
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6654
Practice Address - Country:US
Practice Address - Phone:207-973-8585
Practice Address - Fax:207-973-8817
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0184612080P0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program