Provider Demographics
NPI:1265585954
Name:HAGAN, TRACY A (PA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:HAGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GREEN OAK LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2017
Mailing Address - Country:US
Mailing Address - Phone:412-670-6389
Mailing Address - Fax:
Practice Address - Street 1:400 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-2727
Practice Address - Country:US
Practice Address - Phone:412-444-0098
Practice Address - Fax:412-444-0111
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001523L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical