Healthcare Provider Details

I. General information

NPI: 1992777569
Provider Name (Legal Business Name): CHARLES H HAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST STREET WINCHESTER MEDICAL CENTER
WINCHESTER VA
22601
US

IV. Provider business mailing address

PO BOX 3295
WINCHESTER VA
22604-2495
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-8000
  • Fax:
Mailing address:
  • Phone: 540-662-8336
  • Fax: 540-662-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101035183
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: