Healthcare Provider Details

I. General information

NPI: 1396737383
Provider Name (Legal Business Name): DONALD DOUGLAS HACKENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 GRAHAM RD
CUYAHOGA FALLS OH
44221-1170
US

IV. Provider business mailing address

857 GRAHAM RD
CUYAHOGA FALLS OH
44221-1170
US

V. Phone/Fax

Practice location:
  • Phone: 330-923-9585
  • Fax: 216-427-9148
Mailing address:
  • Phone: 330-923-9585
  • Fax: 216-427-9148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35071363
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: