Provider Demographics
NPI:1578634077
Name:HAGERTY, FAITH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:
Last Name:HAGERTY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 TIDEWATER COLONY DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2592
Mailing Address - Country:US
Mailing Address - Phone:410-266-8010
Mailing Address - Fax:443-782-2498
Practice Address - Street 1:2001 TIDEWATER COLONY DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2592
Practice Address - Country:US
Practice Address - Phone:410-266-8010
Practice Address - Fax:443-782-2498
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD54883608OtherCAREFIRST BLUE SHIELD
MDS4410005OtherCAREFIRST BLUE CHOICE
MD3348488OtherAETNA HEALTH CARE
MD497754OtherMAMSI
MD415MG486Medicare ID - Type Unspecified
MD497754OtherMAMSI