Provider Demographics
NPI:1194935221
Name:HAGIWARA, MARI (MD)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:HAGIWARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 8TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4346
Mailing Address - Country:US
Mailing Address - Phone:917-568-7275
Mailing Address - Fax:
Practice Address - Street 1:660 1ST AVE
Practice Address - Street 2:2ND FLOOR RADIOLOGY, RM 223
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3295
Practice Address - Country:US
Practice Address - Phone:212-263-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243032-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology