Provider Demographics
NPI:1154658805
Name:MICHAEL P HAGGERTY MD LLC
Entity Type:Organization
Organization Name:MICHAEL P HAGGERTY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HAGGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-726-5815
Mailing Address - Street 1:2333 HUNTERS RDG
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-8110
Mailing Address - Country:US
Mailing Address - Phone:330-726-5815
Mailing Address - Fax:330-793-8688
Practice Address - Street 1:5533 MAHONING AVE
Practice Address - Street 2:SUITE D
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2366
Practice Address - Country:US
Practice Address - Phone:330-793-7966
Practice Address - Fax:330-793-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070508H207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0258984Medicaid
OH0258984Medicaid