Healthcare Provider Details

I. General information

NPI: 1225358740
Provider Name (Legal Business Name): MARK P HAGEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARK PAUL HAGEN

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 N HIGH ST STE 202
WORTHINGTON OH
43085-2370
US

IV. Provider business mailing address

7100 N HIGH ST STE 202
WORTHINGTON OH
43085-2370
US

V. Phone/Fax

Practice location:
  • Phone: 614-259-7987
  • Fax: 740-891-2002
Mailing address:
  • Phone: 614-259-7987
  • Fax: 740-891-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34010866
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: