Basic Information
| Provider Information | |||||||||
| NPI: | 1235171406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGY | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | LINDSAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8310 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240140310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403453556 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 KNOTBREAK ROAD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241537304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404444020 | ||||||||
| FaxNumber: | 5404444021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | 0101238696 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 185348 | 01 | VA | ANTHEM | OTHER | 393326001 | 01 | VA | ADMINISTAR FEDERAL | OTHER | 8150571 | 01 | VA | CIGNA | OTHER | 332136 | 01 | VA | SOUTHERN HEALTH | OTHER | 2140840 | 01 | VA | MAMSI | OTHER | 542006922 | 01 | VA | UNITED HEALTHCARE | OTHER | 7849752 | 01 | VA | AETNA | OTHER | 010200601 | 05 | VA | MEDICAID |