Provider Demographics
NPI:1063463024
Name:HAGLER, BRIAN N (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:N
Last Name:HAGLER
Suffix:
Gender:M
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:704-384-8441
Mailing Address - Fax:704-384-8442
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2387
Practice Address - Country:US
Practice Address - Phone:704-384-8441
Practice Address - Fax:704-384-8442
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN0087FMedicaid
NC891370TMedicaid
NC2030399Medicare ID - Type Unspecified
NCNC2336AMedicare PIN
NC891370TMedicaid