Provider Demographics
NPI:1790894897
Name:HAGARTY, SARAH E (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:HAGARTY
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 1:1235 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114461208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-114461Medicaid
ILI59514Medicare UPIN
IL036-114461Medicaid