Provider Demographics
NPI:1477568053
Name:HASENFELD, MARTIN P (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:P
Last Name:HASENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 ORCHARD ST
Mailing Address - Street 2:SUITE 316
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4417
Mailing Address - Country:US
Mailing Address - Phone:203-781-3400
Mailing Address - Fax:203-781-3414
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 316
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-781-3400
Practice Address - Fax:203-781-3414
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0349412081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F88396Medicare UPIN