Healthcare Provider Details

I. General information

NPI: 1326016726
Provider Name (Legal Business Name): EDITH HERGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 CROMWELL AVE SUITE 101
ROCKY HILL CT
06067-1800
US

IV. Provider business mailing address

238 CONGDON ST E
MIDDLETOWN CT
06457-2063
US

V. Phone/Fax

Practice location:
  • Phone: 847-477-3809
  • Fax: 847-477-3809
Mailing address:
  • Phone: 860-996-1569
  • Fax: 860-257-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036082560
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number50738
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: