Healthcare Provider Details

I. General information

NPI: 1235171406
Provider Name (Legal Business Name): MARK LINDSAY HAGY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KNOTBREAK ROAD
SALEM VA
24153-7304
US

IV. Provider business mailing address

PO BOX 8310
ROANOKE VA
24014-0310
US

V. Phone/Fax

Practice location:
  • Phone: 540-444-4020
  • Fax: 540-444-4021
Mailing address:
  • Phone: 540-345-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number0101238696
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: