Provider Demographics
NPI:1891772257
Name:HAGAN, HUGH JOHNSON III (MD)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:JOHNSON
Last Name:HAGAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040796207XS0106X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891772257OtherINTOTAL
VA1891772257OtherHUMANA MEDICARE
VA1891772257OtherMEDICAID OF NORTH CAROLINA
VA1891772257OtherUNITED HEALTHCARE
VA1891772257Medicaid
VA371194700OtherBLACK LUNG
VA540506332115OtherTRICARE
VA1891772257OtherANTHEM
VA1891772257OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1891772257OtherHEALTHKEEPERS
VAP00834690OtherRAILROAD MEDICARE
VA1891772257OtherUMWA
VA1891772257OtherVA PREMIER
VA1891772257OtherCIGNA
VA3810018724OtherMEDICAID OF WEST VIRGINIA
VA1891772257OtherGATEWAY
VA1891772257OtherHEALTHKEEPERS PLUS
VA1891772257OtherVIRGINIA HEALTH NETWORK
VA1891772257OtherOPTIMA HEALTH PLAN
VA1891772257OtherAETNA
VA1891772257OtherHEALTHKEEPERS PLUS