Provider Demographics
NPI:1972899086
Name:O'HAGAN, JOHNATHON C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHON
Middle Name:C
Last Name:O'HAGAN
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 1:9300 DEWITT LOOP
Mailing Address - Street 2:DEPARTMENT OF OB/GYN
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-3442
Mailing Address - Fax:571-231-6757
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:DEPARTMENT OF OB/GYN
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:815-302-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27877207V00000X
VA0101273121207V00000X
ORPG176945207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN