Provider Demographics
NPI:1326019472
Name:HAGEN, AMANDA DARE DURIGG (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DARE DURIGG
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:DARE
Other - Last Name:DURIGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:CLEVELAND CLINIC AT WORK
Mailing Address - Street 2:5595 TRANSPORTATION BLVD. #220
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-587-5431
Mailing Address - Fax:216-587-5474
Practice Address - Street 1:CLEVELAND CLINIC AT WORK
Practice Address - Street 2:5595 TRANSPORTATION BLVD. #220
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125
Practice Address - Country:US
Practice Address - Phone:216-587-5431
Practice Address - Fax:216-587-5474
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260508-12083P0500X
OH35.1276482083P0901X, 2083X0100X
KS04-394612083X0100X
DEC1-0007340208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice