Provider Demographics
NPI:1184691552
Name:HAGGERTY, PATRICK GEORGE (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:GEORGE
Last Name:HAGGERTY
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8999
Mailing Address - Fax:757-446-7922
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 572
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8999
Practice Address - Fax:757-446-7922
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033686207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184691552OtherCOVENTRY HEALTH CARE
VA1184691552OtherUNITED HEALTHCARE
VA1184691552OtherTRICARE/CHAMPUS
NC1184691552Medicaid
VA1184691552OtherCORVEL
VA1184691552OtherAETNA
VA1184691552OtherUSA MANAGED CARE
VA1184691552OtherCIGNA
VA1184691552OtherANTHEM BC/BS
VA1184691552Medicaid
VA1184691552OtherOPTIMA HEALTH
VA1184691552OtherMULTIPLAN
VA1184691552OtherVIRGINIA PREMIER HEALTH PLAN
VA1184691552OtherVIRGINIA HEALTH NETWORK
VA1184691552OtherHUMANA
VAVVL619AMedicare PIN