Healthcare Provider Details

I. General information

NPI: 1124310123
Provider Name (Legal Business Name): MICHAEL JAMES HAGAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 HIGHLAND AVE
FALL RIVER MA
02720
US

IV. Provider business mailing address

2527 CRANBERRY HWY
WAREHAM MA
02571-1046
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-3131
  • Fax:
Mailing address:
  • Phone: 800-841-5200
  • Fax: 508-273-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD15753
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD15753
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: