Provider Demographics
NPI:1467413658
Name:O'HAGAN, ADRIAN R (MD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:R
Last Name:O'HAGAN
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 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-629-8830
Mailing Address - Fax:502-629-7540
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE 1000
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3906
Practice Address - Country:US
Practice Address - Phone:502-629-8830
Practice Address - Fax:502-629-7540
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43400208000000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200985480Medicaid
KY7100117330Medicaid
KYK046821Medicare PIN
KY7100117330Medicaid
KY01457003Medicare PIN