Provider Demographics
NPI:1447305974
Name:HANNESTAD, JONAS O'GARA (MD PHD)
Entity type:Individual
Prefix:DR
First Name:JONAS
Middle Name:O'GARA
Last Name:HANNESTAD
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:227 CHURCH ST
Mailing Address - Street 2:APT 3F
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1817
Mailing Address - Country:US
Mailing Address - Phone:203-974-7536
Mailing Address - Fax:203-974-7662
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0434272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry