Healthcare Provider Details

I. General information

NPI: 1497918452
Provider Name (Legal Business Name): CASEY SHAUN HAGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 KANAWHA AVENUE, SW SUITE 200
SOUTH CHARLESTON WV
25309-1364
US

IV. Provider business mailing address

4610 KANAWHA AVE SW SUITE 200
SOUTH CHARLESTON WV
25309-1367
US

V. Phone/Fax

Practice location:
  • Phone: 304-205-7992
  • Fax: 304-205-7739
Mailing address:
  • Phone: 304-205-7992
  • Fax: 304-205-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22053
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: