Provider Demographics
NPI:1265415830
Name:HAGGE, ROSALIE JANE (MD)
Entity type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:JANE
Last Name:HAGGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:JANE
Other - Last Name:PAISLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-703-2273
Mailing Address - Fax:916-703-2274
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-703-2273
Practice Address - Fax:916-703-2274
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86720207U00000X, 2085R0202X
NC98-00887207U00000X, 2085R0202X
TXL3672207U00000X, 2085R0202X
MOMED101722207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G867200Medicaid
G70979Medicare UPIN
CA00G867200Medicare ID - Type Unspecified