Provider Demographics
NPI:1386602258
Name:THOMAS J HAGAN, DPM
Entity type:Organization
Organization Name:THOMAS J HAGAN, DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:252-633-3400
Mailing Address - Street 1:612A MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5231
Mailing Address - Country:US
Mailing Address - Phone:252-633-3400
Mailing Address - Fax:252-633-9338
Practice Address - Street 1:612A MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5231
Practice Address - Country:US
Practice Address - Phone:252-633-3400
Practice Address - Fax:252-633-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC137213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08079OtherBCBSNC PROVIDER NUMBER
NC015MEOtherBCBSNC GROUP NUMBER
NC1962406991OtherINDIVIDUAL NPI
NC7908079Medicaid
NC243067Medicare ID - Type UnspecifiedPROVIDER NUMBER
NC0916530001Medicare NSC
NC7908079Medicaid