Healthcare Provider Details

I. General information

NPI: 1902895543
Provider Name (Legal Business Name): TOD HAGINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 WASHINGTON ST
WEIRTON WV
26062-5343
US

IV. Provider business mailing address

3920 WASHINGTONST
WEIRTON WV
26062
US

V. Phone/Fax

Practice location:
  • Phone: 304-748-3780
  • Fax:
Mailing address:
  • Phone: 304-723-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18832
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: