1740243468 NPI number — CHRISTOPHER MATHEW HAGEMANN ATC

Table of content: CHRISTOPHER MATHEW HAGEMANN ATC (NPI 1740243468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740243468 NPI number — CHRISTOPHER MATHEW HAGEMANN ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGEMANN
Provider First Name:
CHRISTOPHER
Provider Middle Name:
MATHEW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740243468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 MERROW RD
Provider Second Line Business Mailing Address:
APT 4
Provider Business Mailing Address City Name:
TOLLAND
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06084-3964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-489-1873
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2095 HILLSIDE RD
Provider Second Line Business Practice Location Address:
UNIT 3078
Provider Business Practice Location Address City Name:
STORRS
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06269-9017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-486-6353
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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