MEDICARE: MARCEA P HAGANS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1750212643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCEA P HAGANS

Provider Business Mailing Address
First Line	:	5231 SHASTA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-9115
Country	:	US
Telephone Number	:	937-723-8475
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 HOOVER AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-5238
Country	:	US
Telephone Number	:	937-723-8475
Fax Number	:

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

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ MARCEA P HAGANS ” Practice Location

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