Provider Demographics
NPI:1366700221
Name:HAGEN, ELISE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:MARIE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CAREMOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:6734 ROUTE 9
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3724
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:845-202-6713
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2016-11-17
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Provider Licenses
StateLicense IDTaxonomies
NY265815207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03474971Medicaid
NY03474971Medicaid
NYA400043679Medicare PIN