Provider Demographics
NPI:1912975459
Name:HASTRUP, FRANTZ C (MD)
Entity Type:Individual
Prefix:
First Name:FRANTZ
Middle Name:C
Last Name:HASTRUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HOSPITAL PLZ STE 505
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-348-2437
Mailing Address - Fax:203-276-7243
Practice Address - Street 1:29 HOSPITAL PLZ STE 505
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-348-2437
Practice Address - Fax:203-276-7243
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT62669207RC0200X, 207RP1001X
MA218885207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2029961Medicaid
MAJ27040OtherBCBSMA
MAAA7989OtherHARVARD PILGRIM
MAA36443Medicare ID - Type Unspecified
MA2029961Medicaid