Healthcare Provider Details

I. General information

NPI: 1932761996
Provider Name (Legal Business Name): FATIMA HAQQANI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST
SPRINGFIELD MA
01199-5009
US

IV. Provider business mailing address

759 CHESTNUT ST
SPRINGFIELD MA
01199-5009
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS22875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: