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General NPI Number Information
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NPI Number | 1780540104
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Entity Type | Individual
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Provider Name | DEANNE MARIE O'BRIEN HAGERTY PA
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Gender | Female
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 840 HARRISON AVE
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City | BOSTON
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State | MA
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Zip | 02118
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Country | US
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Telephone | 617-638-6610
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Fax |
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE FLR 2
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City | BOSTON
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State | MA
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Zip | 02118
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Country | US
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Telephone | 617-414-5405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA102329
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License Number State | MA
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