Provider Demographics
NPI:1598732950
Name:HOBERMAN, DENA A (MD)
Entity type:Individual
Prefix:DR
First Name:DENA
Middle Name:A
Last Name:HOBERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 DWIGHT RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1748
Mailing Address - Country:US
Mailing Address - Phone:413-567-1031
Mailing Address - Fax:413-567-7683
Practice Address - Street 1:115 ELM ST
Practice Address - Street 2:SUITE 107
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3712
Practice Address - Country:US
Practice Address - Phone:860-745-3336
Practice Address - Fax:860-741-2654
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042215208000000X
MA220260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I08542Medicare UPIN
HO A36879Medicare ID - Type Unspecified