MEDICARE: DR. THOMAS HAGOPIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	A141069	CA

General Provider Information

NPI Number	:	1023484037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS HAGOPIAN M.D.

Provider Business Mailing Address
First Line	:	99 KROG ST NE UNIT C110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2677
Country	:	US
Telephone Number	:	404-885-8542
Fax Number	:	404-885-8547

Provider Business Practice Location Address
First Line	:	99 KROG ST NE UNIT C110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2677
Country	:	US
Telephone Number	:	404-885-8542
Fax Number	:	404-885-8547

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	05/28/2023

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