Healthcare Provider Details

I. General information

NPI: 1003985813
Provider Name (Legal Business Name): THOMAS HAGAMEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 HIGH ST GREENFIELD
GREENFIELD MA
01301-2613
US

IV. Provider business mailing address

280 CHESTNUT ST SPRINGFIELD
SPRINGFIELD MA
01199-1000
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-2263
  • Fax:
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number52701
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52701
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: