Provider Demographics
NPI:1770659674
Name:HAUPT, DONNA ELLEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ELLEN
Last Name:HAUPT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 NEWTOWN RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4180
Mailing Address - Country:US
Mailing Address - Phone:203-830-4700
Mailing Address - Fax:203-730-4166
Practice Address - Street 1:107 NEWTOWN RD STE 2A
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4180
Practice Address - Country:US
Practice Address - Phone:203-830-4700
Practice Address - Fax:203-730-4166
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001041363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP32942Medicare UPIN
CT970000793Medicare ID - Type Unspecified