Basic Information
| Provider Information | |||||||||
| NPI: | 1356333439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGBERG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 FRANCIS ST | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176328383 | ||||||||
| FaxNumber: | 6176327562 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 FRANCIS ST | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176328383 | ||||||||
| FaxNumber: | 6176327562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 227057 | MA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 2114747 | 05 | MA | MEDICAID |