Provider Demographics
NPI:1720052368
Name:HAGSTROM, J. NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:NATHAN
Last Name:HAGSTROM
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 1754
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-1754
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:2545 SHOENERSVILLE ROAD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:610-969-2540
Practice Address - Fax:610-969-3074
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0369092080P0207X
PAMD054176L2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001369091Medicaid
CT001369091Medicaid
CTG74436Medicare UPIN