1841532033 NPI number — ANNA FAHY HAGAN M.D.

Table of content: ANNA FAHY HAGAN M.D. (NPI 1841532033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841532033 NPI number — ANNA FAHY HAGAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGAN
Provider First Name:
ANNA
Provider Middle Name:
FAHY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAHY
Provider Other First Name:
ANNA
Provider Other Middle Name:
LAURA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841532033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 S COLUMBIAN WAY
Provider Second Line Business Mailing Address:
GENERAL INTERNAL MEDICINE CLINIC
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98108-1532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-277-4198
Provider Business Mailing Address Fax Number:
206-764-2936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-520-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2013

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: 207R00000X , with the licence number:  MD60574245 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: MD60574245 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1841532033 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".