Healthcare Provider Details

I. General information

NPI: 1922047810
Provider Name (Legal Business Name): KAY HAEDICKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 GOOSE LANE SUITE 1300
GUILFORD CT
06437
US

IV. Provider business mailing address

19 LUNAR DRIVE
WOODBRIDGE CT
06525
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-9192
  • Fax: 203-453-0875
Mailing address:
  • Phone: 203-389-7504
  • Fax: 203-389-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number026723
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: