1184780306 NPI number — JOSEPH HAGAN, MD

Table of content: (NPI 1184780306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184780306 NPI number — JOSEPH HAGAN, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH HAGAN, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184780306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLAND
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02370-0052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-585-9522
Provider Business Mailing Address Fax Number:
781-585-9544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03743-4921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-585-9522
Provider Business Practice Location Address Fax Number:
781-585-9544
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAGAN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
781-585-9522

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  NH9963 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0105606Y0NH01 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30011218 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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