1790781862 NPI number — CHARLES L HAGEMAN MD

Table of content: CHARLES L HAGEMAN MD (NPI 1790781862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790781862 NPI number — CHARLES L HAGEMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGEMAN
Provider First Name:
CHARLES
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1790781862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45005-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-424-1440
Provider Business Mailing Address Fax Number:
513-424-1422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45005-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-424-1440
Provider Business Practice Location Address Fax Number:
513-424-1422
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  35050018 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 641549 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0705106 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0720338 . This is a "JF MOLLOY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 160009444 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: T001806 . This is a "CHOICE CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0720338 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3152677002 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000275780 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com