Provider Demographics
NPI:1629236294
Name:HALLBERGSON, ANNA LEWIS (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEWIS
Last Name:HALLBERGSON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:HALLBERGSON
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:192 PLEASANT ST
Mailing Address - Street 2:APT 2
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4810
Mailing Address - Country:US
Mailing Address - Phone:847-736-4834
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:CHILDREN'S HOSPITAL BOSTON PEDIARIC RESIDENCY PROGRAM
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232892208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics