Provider Demographics
NPI:1124299813
Name:HAGER, ANGELA M (PA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:HAGER
Suffix:
Gender:F
Credentials:PA
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 29
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26571-0029
Mailing Address - Country:US
Mailing Address - Phone:304-825-6554
Mailing Address - Fax:304-825-1371
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26571-0029
Practice Address - Country:US
Practice Address - Phone:304-825-6554
Practice Address - Fax:304-825-1371
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV30991Medicare PIN