Healthcare Provider Details

I. General information

NPI: 1821368564
Provider Name (Legal Business Name): JOHN HENRY HAGMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 JOR SYD LN
PARTLOW VA
22534-9655
US

IV. Provider business mailing address

8901 JOR SYD LN
PARTLOW VA
22534-9655
US

V. Phone/Fax

Practice location:
  • Phone: 571-220-8710
  • Fax:
Mailing address:
  • Phone: 571-220-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101226760
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: