Provider Demographics
NPI:1477694248
Name:HAGAN, LEIGH DOUGLAS (PHD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:DOUGLAS
Last Name:HAGAN
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:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-0005
Mailing Address - Country:US
Mailing Address - Phone:804-748-8480
Mailing Address - Fax:
Practice Address - Street 1:10003 COURTVIEW LN
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6682
Practice Address - Country:US
Practice Address - Phone:804-748-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist