Individual
DR. JOANNA H FOGG-WABERSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 RETREAT AVE, INSTITUTE OF LIVING, HARTFORD, CT 06106-3309
(860) 545-7189
Mailing address
PO BOX 40,000 DEPT 634, HARTFORD HOSPITAL PROFESSIONAL SERVICES, HARTFORD, CT 06151-0634
(860) 545-7602
(860) 545-7601
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
028417
CT
2084P0805X
Geriatric Psychiatry Physician
028417
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001284173
—
CT
Enumeration date
08/15/2006
Last updated
12/06/2016
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