Healthcare Provider Details

I. General information

NPI: 1982050472
Provider Name (Legal Business Name): HAGAR HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE SUITE E 208
CLINTON MD
20735-1628
US

IV. Provider business mailing address

330 RIDGELY ST
UPPER MARLBORO MD
20774-1929
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-7458
  • Fax: 301-856-7340
Mailing address:
  • Phone: 301-856-7458
  • Fax: 301-856-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23635
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT100000079
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number02515
License Number StateMD

VIII. Authorized Official

Name: LORI A. ROBINSON
Title or Position: OWNER
Credential:
Phone: 301-856-7458