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
StateLicense IDTaxonomies
KYR3501207R00000X
390200000X
NC01047207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program