Provider Demographics
NPI:1578107959
Name:KAGGWA, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:KAGGWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PRINCETON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1559
Mailing Address - Country:US
Mailing Address - Phone:978-291-6978
Mailing Address - Fax:978-256-6579
Practice Address - Street 1:73 PRINCETON ST STE 203
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1559
Practice Address - Country:US
Practice Address - Phone:978-291-6978
Practice Address - Fax:978-256-6579
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2269325163WH0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty