Provider Demographics
NPI:1609462910
Name:DR SARAH E HAGARTY, LLC
Entity Type:Organization
Organization Name:DR SARAH E HAGARTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-405-1479
Mailing Address - Street 1:1235 N MULFORD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3879
Mailing Address - Country:US
Mailing Address - Phone:815-965-6644
Mailing Address - Fax:815-965-2901
Practice Address - Street 1:1235 N MULFORD RD STE 200
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3879
Practice Address - Country:US
Practice Address - Phone:815-965-6644
Practice Address - Fax:815-965-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty