Healthcare Provider Details

I. General information

NPI: 1629059779
Provider Name (Legal Business Name): PETER MACLEAN HOAGLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 BERGER AVE
SAN DIEGO CA
92123-4233
US

IV. Provider business mailing address

3131 BERGER AVE STE 200
SAN DIEGO CA
92123-4203
US

V. Phone/Fax

Practice location:
  • Phone: 858-244-6800
  • Fax: 858-244-6909
Mailing address:
  • Phone: 858-244-6800
  • Fax: 858-244-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG54598
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberG54598
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberG54598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: