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Individual

DAHLIA A SAAD PENDERGRASS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
80 SEYMOUR STREET, HARTFORD HOSPITAL PSYCHIATRY DEPT, HARTFORD, CT 06102-5037
(860) 545-2629
Mailing address
PO BOX 415933, HARTFORD HOSPITAL PROFESSIONAL SERVICES, BOSTON, MA 02241-5933
(860) 545-7602

Taxonomy

Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
049137
CT
2084P0800X
Psychiatry Physician
Primary
049137
CT
2084P0800X
Psychiatry Physician
42062
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
358640500
MN
01
P00003148
MEDICARE RAILROAD
MN
05
PENDING
CT
Enumeration date
12/07/2005
Last updated
10/22/2010
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