Provider Demographics
NPI: | 1841606308 |
---|---|
Name: | HAGER, MATTHEW ROLAND (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MATTHEW |
Middle Name: | ROLAND |
Last Name: | HAGER |
Suffix: | |
Gender: | M |
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: | 1006 WH SMITH BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | GREENVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27834-5051 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-413-6683 |
Mailing Address - Fax: | 252-756-0211 |
Practice Address - Street 1: | 1006 WH SMITH BLVD |
Practice Address - Street 2: | |
Practice Address - City: | GREENVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27834-5051 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-413-6683 |
Practice Address - Fax: | 252-756-0211 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-07-05 |
Last Update Date: | 2019-09-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | R3501 | 207R00000X |
390200000X | ||
NC | 01047 | 207RE0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |