Provider Demographics
NPI:1740211283
Name:HAGERTY, JOHN JAY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAY
Last Name:HAGERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:207-973-5163
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:NICU PROFESSIONAL SERVICES EMMC
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-8670
Practice Address - Fax:207-973-5163
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0153012080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8517Medicare ID - Type Unspecified
MEH26117Medicare UPIN