1437364742 NPI number — SEAN CARLTON HAGENBUCH MD, FAAP, FACC

Table of content: SEAN CARLTON HAGENBUCH MD, FAAP, FACC (NPI 1437364742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437364742 NPI number — SEAN CARLTON HAGENBUCH MD, FAAP, FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGENBUCH
Provider First Name:
SEAN
Provider Middle Name:
CARLTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, FAAP, FACC
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:
1437364742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 WHITING HILL RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWER
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04412-1006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-973-5000
Provider Business Mailing Address Fax Number:
207-973-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PEDIATRIC OP SPECIALTY CARE- CARDIOLOGY
Provider Second Line Business Practice Location Address:
417 STATE ST WEBBER EAST #305
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-6654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-973-8585
Provider Business Practice Location Address Fax Number:
207-973-8817
Provider Enumeration Date:
05/11/2007

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: 2080P0202X , with the licence number:  018461 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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