Provider Demographics
NPI:1285915264
Name:HAGEN, INGRID M (MD)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:M
Last Name:HAGEN
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 1:1352 COMMUNITY DR.
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-7434
Mailing Address - Country:US
Mailing Address - Phone:970-586-4386
Mailing Address - Fax:
Practice Address - Street 1:1352 COMMUNITY DR.
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-7434
Practice Address - Country:US
Practice Address - Phone:970-586-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13577208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice