Healthcare Provider Details

I. General information

NPI: 1003906363
Provider Name (Legal Business Name): TIMOTHY VERNON HAGY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 WEST AVE
BROCKPORT NY
14420-1229
US

IV. Provider business mailing address

156 WEST AVE
BROCKPORT NY
14420-1229
US

V. Phone/Fax

Practice location:
  • Phone: 585-395-6095
  • Fax:
Mailing address:
  • Phone: 585-395-6095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number169821
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: