Provider Demographics
NPI:1962776393
Name:HAGGERTY, SARAH THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:THOMAS
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 JUSTIS ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-2516
Mailing Address - Country:US
Mailing Address - Phone:757-420-8297
Mailing Address - Fax:
Practice Address - Street 1:1016 JUSTIS ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-2516
Practice Address - Country:US
Practice Address - Phone:757-420-8297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant