Healthcare Provider Details

I. General information

NPI: 1588764633
Provider Name (Legal Business Name): DAVID MARTIN AGGER LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TER HEUN DR
FALMOUTH MA
02540-2525
US

IV. Provider business mailing address

200 TER HEUN DR
FALMOUTH MA
02540-2525
US

V. Phone/Fax

Practice location:
  • Phone: 508-540-6550
  • Fax: 508-540-7480
Mailing address:
  • Phone: 508-540-6550
  • Fax: 508-540-7480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number06784
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: