Healthcare Provider Details

I. General information

NPI: 1366718140
Provider Name (Legal Business Name): HANNAH DUGGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

201 RIDGEWAY AVE APT 3
OAKLAND CA
94611-5101
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3000
  • Fax:
Mailing address:
  • Phone: 917-597-8066
  • Fax: 510-763-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA118969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: