Provider Demographics
NPI:1477667301
Name:HAGES, HARRY A (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:A
Last Name:HAGES
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 1:215 OLD TAPPAN ROAD
Mailing Address - Street 2:OLD TAPPAN PEDIATRICS
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-666-1000
Mailing Address - Fax:201-666-7610
Practice Address - Street 1:215 OLD TAPPAN ROAD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-1000
Practice Address - Fax:201-666-7610
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02659100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
010026591NJ01OtherANTHEM HEALTH
13346OtherUSHC
NJ2483505Medicaid
F01392OtherF01392
4243977OtherAETNA
221941517008OtherPRUDENTIAL
23737OtherMASTERCARE
80604OtherAMERIGROUP
998609OtherREFERRAL
1543264OtherUNITEDHLTHCR
4334712003OtherCIGNA
701101OtherEMPIRE HLTHCR
BP038OtherOXFORD
BP038OtherOXFORD
1543264OtherUNITEDHLTHCR