1376814293 NPI number — GAGNON ONCOLOGY, LLC

Table of content: (NPI 1447323100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376814293 NPI number — GAGNON ONCOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAGNON ONCOLOGY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376814293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 LODER ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HORNELL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14843-1950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-465-5278
Provider Business Mailing Address Fax Number:
607-324-7615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1562 OPOSSUMTOWN PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-566-4500
Provider Business Practice Location Address Fax Number:
301-694-5554
Provider Enumeration Date:
01/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LOSECCO
Authorized Official First Name:
LYNDA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
607-324-2340

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  D0039954 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 758511000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com