Individual
JOHN HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
827 LINDEN AVE, BALTIMORE, MD 21201-4606
(410) 328-8141
(410) 328-0177
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-8040
(443) 462-3514
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
R079848
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
419031900
—
MD
01
—
960548-01 & 02
BLUE CROSS/BLUE SHIELD
MD
01
—
S062-0376
BLUE CROSS REGIONAL
MD
Enumeration date
07/17/2007
Last updated
05/28/2019
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