Provider Demographics
NPI:1386916278
Name:E WAYNE HAGA MD FAMILY PRACTICE PC
Entity type:Organization
Organization Name:E WAYNE HAGA MD FAMILY PRACTICE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-880-9047
Mailing Address - Street 1:2115 EXECUTIVE DR
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2499
Mailing Address - Country:US
Mailing Address - Phone:757-262-0002
Mailing Address - Fax:757-262-0007
Practice Address - Street 1:2115 EXECUTIVE DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2499
Practice Address - Country:US
Practice Address - Phone:757-262-0002
Practice Address - Fax:757-262-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty