Provider Demographics
NPI:1497918452
Name:HAGER, CASEY SHAUN (MD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:SHAUN
Last Name:HAGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4610 KANAWHA AVE SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1367
Mailing Address - Country:US
Mailing Address - Phone:304-205-7992
Mailing Address - Fax:304-205-7739
Practice Address - Street 1:4610 KANAWHA AVENUE, SW
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-205-7992
Practice Address - Fax:304-205-7739
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV22053207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease