Provider Demographics
NPI:1053191585
Name:HAGG, VICTORIA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:HAGG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6268
Mailing Address - Country:US
Mailing Address - Phone:203-797-1500
Mailing Address - Fax:
Practice Address - Street 1:2 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6268
Practice Address - Country:US
Practice Address - Phone:203-797-1500
Practice Address - Fax:203-730-9507
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-01-25
Deactivation Date:2024-01-19
Deactivation Code:
Reactivation Date:2024-01-24
Provider Licenses
StateLicense IDTaxonomies
CT6247363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty