Individual
DR. SEAN MATTHEW HACKING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MB,BCH,BAO
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-5057
Mailing address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-5057
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
312719
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/07/2017
Last updated
09/18/2023
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