Provider Demographics
NPI:1730181348
Name:HECHT, AGATHA (APRN)
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:
Last Name:HECHT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-6581
Mailing Address - Fax:860-714-8311
Practice Address - Street 1:94 WOODLAND ST
Practice Address - Street 2:CANCER CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1217
Practice Address - Country:US
Practice Address - Phone:860-714-4680
Practice Address - Fax:860-714-8057
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004245090Medicaid
CT004245090Medicaid
CT500001330Medicare ID - Type Unspecified