MEDICARE: MAURA KELLY HAGAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	0101047847	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110056024	OTHER	VA	RR MEDICARE
4	C01120	OTHER	VA	MEDICARE GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	237410	OTHER	VA	ANTHEM BCBS VA

General Provider Information

NPI Number	:	1699738260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURA KELLY HAGAN M.D.

Provider Business Mailing Address
First Line	:	7202 GLEN FOREST DR
Second Line	:	STE 200
City	:	RICHMOND
State	:	VA
Zip	:	23226-3781
Country	:	US
Telephone Number	:	804-673-0134
Fax Number	:	804-673-1796

Provider Business Practice Location Address
First Line	:	7501 RIGHT FLANK RD
Second Line	:	SUITE 600
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-1815
Country	:	US
Telephone Number	:	804-559-2489
Fax Number	:	804-730-5847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	05/21/2021

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