Provider Demographics
NPI:1497946974
Name:MARION L. HAGAN M.D.
Entity Type:Organization
Organization Name:MARION L. HAGAN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-936-4515
Mailing Address - Street 1:567 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FRENCH LICK
Mailing Address - State:IN
Mailing Address - Zip Code:47432-2245
Mailing Address - Country:US
Mailing Address - Phone:812-936-4515
Mailing Address - Fax:812-936-4536
Practice Address - Street 1:567 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:FRENCH LICK
Practice Address - State:IN
Practice Address - Zip Code:47432-2245
Practice Address - Country:US
Practice Address - Phone:812-936-4515
Practice Address - Fax:812-936-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000081178OtherBLUE SHEILD
000000081178OtherBLUE SHEILD
600190Medicare PIN