Doctor Name: | ZACHARY CHANCELLOR HAGERMAN |
NPI Number: | 1790751972 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CORPSMAN |
License Number: | |
Business Practice Address: | 15 Mohegan Ave New London, CT - 063208100 |
Business Phone Number: | 8607016999 |
Business Fax Number: | 8604448413 |
Mailing Address: | 15 Mohegan Ave, NEW LONDON |
State: | CT |
Postal Code: | 063208100 |
Phone Number: | 8607016999 |
Fax Number: | 8604448413 |
NPI Enumeration Date: | 02/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |