Healthcare Provider Details

I. General information

NPI: 1184940363
Provider Name (Legal Business Name): MICHELLE MORIAH HAGOPIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 PENNSYLVANIA AVE STE 690
FORT WORTH TX
76104-2133
US

IV. Provider business mailing address

3150 MATLOCK RD STE 407
ARLINGTON TX
76015-2924
US

V. Phone/Fax

Practice location:
  • Phone: 817-761-7740
  • Fax: 817-761-7742
Mailing address:
  • Phone: 817-375-9790
  • Fax: 817-375-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR8204
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberR8204
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: