Provider Demographics
NPI:1164728895
Name:HAGEMASTER, ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:HAGEMASTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:TAMC PSYCHOLOGY ATTN: MAJ HAGEMASTER
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-3281
Mailing Address - Fax:808-433-1466
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:TAMC PSYCHOLOGY ATTN: MAJ HAGEMASTER
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-3281
Practice Address - Fax:808-433-1466
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04719103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN