MEDICARE: MARY M HAGERTY MD

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	207RR0500X	Rheumatology Physician	0101048922	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942279195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M HAGERTY MD

Provider Business Mailing Address
First Line	:	420 W JUBAL EARLY DR STE 104
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6435
Country	:	US
Telephone Number	:	540-667-6232
Fax Number	:	540-667-6036

Provider Business Practice Location Address
First Line	:	420 W JUBAL EARLY DR STE 104
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6435
Country	:	US
Telephone Number	:	540-667-6232
Fax Number	:	540-667-6036

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	03/23/2023

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