Provider Demographics
NPI:1619929940
Name:HAGAN, SARAH TAM (PA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:TAM
Last Name:HAGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:205 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6535
Mailing Address - Country:US
Mailing Address - Phone:757-962-1217
Mailing Address - Fax:757-962-1254
Practice Address - Street 1:844 KEMPSVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-261-0700
Practice Address - Fax:757-261-0701
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001715363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ20294Medicare UPIN