Provider Demographics
NPI:1528048329
Name:HACKMAN, JAN TERRY (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:TERRY
Last Name:HACKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:HACKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:99 EAST RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:860-282-4133
Mailing Address - Fax:860-289-0742
Practice Address - Street 1:80 SEYMOUR STREET
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5539
Practice Address - Country:US
Practice Address - Phone:860-545-2117
Practice Address - Fax:860-289-0742
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028109207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001281097Medicaid
A58668Medicare UPIN
CT001281097Medicaid