Healthcare Provider Details

I. General information

NPI: 1326475682
Provider Name (Legal Business Name): MICHAEL HOAGLAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6934 AVIATION BLVD SUITE B
GLEN BURNIE MD
21061-2593
US

IV. Provider business mailing address

984 MILL CIR # 94
ALLIANCE OH
44601-5176
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax:
Mailing address:
  • Phone: 216-334-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC05229
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: