Provider Demographics
NPI:1124139241
Name:HAGAN, SUSAN E (MD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:HAGAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:502-772-8189
Practice Address - Street 1:1000 NEIGHBORHOOD PL
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:KY
Practice Address - Zip Code:40118-9697
Practice Address - Country:US
Practice Address - Phone:502-361-2381
Practice Address - Fax:502-996-8309
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01092149A207V00000X
KY40340207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000596343OtherANTHEM - WS
KY100205OtherSIHO - WS
KY000023034SOtherHUMANA - WS
OH2691930Medicaid
KYP00912082OtherRAILROAD MEDICARE
KY00533083OtherMEDICARE - WSP
IN200941180Medicaid
KY50021335OtherPASSPORT - WS
KY64125552Medicaid
OH2691930Medicaid
IN200941180Medicaid