Individual
AMY JEAN HAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
RED LION RD AT KNIGHTS RD, PHILADELPHIA, PA 19114
(215) 824-2260
Mailing address
4041 RIDGE AVE APT 18412, PHILADELPHIA, PA 19129-1557
(619) 977-3854
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
20A11132
CA
207P00000X
Emergency Medicine Physician
OTO11845
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093992901
—
CA
Enumeration date
01/23/2008
Last updated
07/14/2010
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