Provider Demographics
NPI:1609190636
Name:HAGEMANN, COLLEEN SHANNON (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:SHANNON
Last Name:HAGEMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 AMELIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3622
Mailing Address - Country:US
Mailing Address - Phone:504-952-6322
Mailing Address - Fax:504-897-4876
Practice Address - Street 1:1426 AMELIA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115
Practice Address - Country:US
Practice Address - Phone:504-952-6322
Practice Address - Fax:504-897-4876
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2070832084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry