Provider Demographics
NPI:1902895543
Name:HAGINS, TOD (MD)
Entity Type:Individual
Prefix:DR
First Name:TOD
Middle Name:
Last Name:HAGINS
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 1:3920 WASHINGTONST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-723-6040
Mailing Address - Fax:
Practice Address - Street 1:3920 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5343
Practice Address - Country:US
Practice Address - Phone:304-748-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5630416000Medicaid
OH2073901Medicaid
WV5630416000Medicaid
WV0846638Medicare PIN
OH0846637Medicare ID - Type Unspecified