Provider Demographics
NPI:1154390045
Name:HACKETT, ANNE ELDER (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ELDER
Last Name:HACKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9177
Mailing Address - Country:US
Mailing Address - Phone:304-288-1930
Mailing Address - Fax:304-594-9241
Practice Address - Street 1:1613 N. HARRISON PARKWAY SUITE 200
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:954-683-0649
Practice Address - Fax:954-514-3922
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14075207L00000X
PAMD035921E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0058310000Medicaid
WV0058310000Medicaid
WVHA6021511Medicare ID - Type Unspecified