Provider Demographics
NPI:1386645034
Name:HAGERTY, GENEVIEVE B (MD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:B
Last Name:HAGERTY
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 1:5687 WILCOX RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-1256
Mailing Address - Country:US
Mailing Address - Phone:614-339-3299
Mailing Address - Fax:
Practice Address - Street 1:500 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8998
Practice Address - Country:US
Practice Address - Phone:380-898-4054
Practice Address - Fax:380-898-8674
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077048207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2342414Medicaid
OHHA4084892Medicare ID - Type Unspecified
OH2342414Medicaid
OH9364211Medicare PIN