Provider Demographics
NPI:1255779393
Name:HAGER, KATHLEEN C (DO)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:HAGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E TOWN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4602
Mailing Address - Country:US
Mailing Address - Phone:614-788-5400
Mailing Address - Fax:614-788-5500
Practice Address - Street 1:290 E TOWN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4602
Practice Address - Country:US
Practice Address - Phone:614-788-5400
Practice Address - Fax:614-788-5500
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012828207R00000X
OH34.012828207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01927635OtherRAILROAD MEDICARE
OH0197356Medicaid
OHH494630OtherMEDICARE