Provider Demographics
NPI:1659638443
Name:HAGELE, THOMAS J
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HAGELE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1362
Mailing Address - Country:US
Mailing Address - Phone:220-564-7955
Mailing Address - Fax:220-564-7956
Practice Address - Street 1:1717 W MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1362
Practice Address - Country:US
Practice Address - Phone:220-564-7955
Practice Address - Fax:220-564-8956
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.127460207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology