Healthcare Provider Details

I. General information

NPI: 1205185006
Provider Name (Legal Business Name): JOSHUA WAYNE HAGEN M.D. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 STONEWOOD DR STE 200
WEXFORD PA
15090-8386
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 724-778-3020
  • Fax: 724-778-3024
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD461197
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD461197
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: