Healthcare Provider Details

I. General information

NPI: 1124472543
Provider Name (Legal Business Name): CARA M HANNIGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 READE PL STE 2100
POUGHKEEPSIE NY
12601-3968
US

IV. Provider business mailing address

21 READE PL STE 2100
POUGHKEEPSIE NY
12601-3968
US

V. Phone/Fax

Practice location:
  • Phone: 845-214-1840
  • Fax:
Mailing address:
  • Phone: 845-214-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT210368
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number68564
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number294775
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number294775
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number294775
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number337805-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: