Provider Demographics
NPI:1538113873
Name:HAGE, DOUGLAS D (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:HAGE
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 1:905 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1066
Mailing Address - Country:US
Mailing Address - Phone:716-825-1398
Mailing Address - Fax:716-825-3834
Practice Address - Street 1:7020 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9306
Practice Address - Country:US
Practice Address - Phone:716-947-4545
Practice Address - Fax:716-947-6146
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188832207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000511489002OtherBC BS WNY
NY000511489004OtherBC BS WNY
NY0707767OtherINDEPENDENT HEALTH
NY01530221Medicaid
NY00010071602OtherUNIVERA HEALTHCARE
F41671Medicare UPIN
NY01530221Medicaid