Provider Demographics
NPI:1962627265
Name:HAGEN, CHAD CAMERON (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:CAMERON
Last Name:HAGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10201 SE MAIN ST STE 29
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2937
Mailing Address - Country:US
Mailing Address - Phone:503-261-4475
Mailing Address - Fax:503-261-4476
Practice Address - Street 1:10201 SE MAIN ST STE 29
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2937
Practice Address - Country:US
Practice Address - Phone:503-261-4475
Practice Address - Fax:503-261-4476
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD249712084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine