1053626523 NPI number — DEBRA ANNE GAGE APRN

Table of content: DEBRA ANNE GAGE APRN (NPI 1053626523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053626523 NPI number — DEBRA ANNE GAGE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAGE
Provider First Name:
DEBRA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCDERMOTT
Provider Other First Name:
DEBRA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053626523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 SEYMOUR STRET
Provider Second Line Business Mailing Address:
HARTFORD HOSPITAL CANCER CENTER
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06102-5037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
869-674-0088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 FISHER DRIVE
Provider Second Line Business Practice Location Address:
HARTFORD HOSPITAL CANCER CENTER
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-674-0088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2010

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: 363L00000X , with the licence number:  004135 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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