Provider Demographics
NPI:1205589488
Name:HOAG, JAMES EDWARD III
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:HOAG
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 CARRIAGE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-2840
Mailing Address - Country:US
Mailing Address - Phone:216-372-0434
Mailing Address - Fax:
Practice Address - Street 1:190 CURRIE HALL PKWY STE A
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4312
Practice Address - Country:US
Practice Address - Phone:330-673-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103699-TRNE390200000X
OHC.2305203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program