Provider Demographics
NPI:1831184449
Name:HAGERTY, THOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:HAGERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6805 ROUTE 9
Mailing Address - Street 2:SUITE 31
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1148
Mailing Address - Country:US
Mailing Address - Phone:845-876-3868
Mailing Address - Fax:845-876-3756
Practice Address - Street 1:117 MARYS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5849
Practice Address - Country:US
Practice Address - Phone:845-338-0789
Practice Address - Fax:845-334-9150
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2017201208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01649834Medicaid
NY240004393Medicare PIN
NYE46624Medicare UPIN
NY01649834Medicaid