Provider Demographics
NPI:1134393283
Name:AWKAL, HANNA DASTIGIR (MD)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:DASTIGIR
Last Name:AWKAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 MEMORIAL DRIVE
Mailing Address - Street 2:FAIRVIEW PEDIATRICS, LLC
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020
Mailing Address - Country:US
Mailing Address - Phone:413-593-1333
Mailing Address - Fax:413-593-1444
Practice Address - Street 1:1176 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-3958
Practice Address - Country:US
Practice Address - Phone:413-593-1333
Practice Address - Fax:413-593-1444
Is Sole Proprietor?:No
Enumeration Date:2008-04-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248887208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics