Provider Demographics
NPI:1487773842
Name:HAGAMAN, JARED T (MD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:T
Last Name:HAGAMAN
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 1:216 W WALNUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1832
Mailing Address - Country:US
Mailing Address - Phone:859-239-5870
Mailing Address - Fax:859-239-5879
Practice Address - Street 1:216 W WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1832
Practice Address - Country:US
Practice Address - Phone:859-239-5870
Practice Address - Fax:859-239-5879
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088250207R00000X
OH35088250207RP1001X, 207RC0200X
KY47928207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2755906Medicaid
KY7100021130Medicaid
KYK104320Medicare PIN
OH2755906Medicaid