Individual
DR. MATTHEW CARLISLE HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
234 GOODMAN ST, CINCINNATI, OH 45219-2364
(513) 584-7284
(513) 584-3807
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 585-5507
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
207ZN0500X
Neuropathology Physician
Primary
35 097773
OH
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
35097773
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0051637
—
OH
Enumeration date
06/24/2008
Last updated
12/12/2017
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