1689623902 NPI number — HARVEY JAY KAGAN M.D.

Table of content: HARVEY JAY KAGAN M.D. (NPI 1689623902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689623902 NPI number — HARVEY JAY KAGAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAGAN
Provider First Name:
HARVEY
Provider Middle Name:
JAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1689623902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
885 KEMPSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23502-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-461-6342
Provider Business Mailing Address Fax Number:
757-963-6158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
885 KEMPSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-461-6342
Provider Business Practice Location Address Fax Number:
757-963-6158
Provider Enumeration Date:
05/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  0101026429 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13261 . This is a "OPTIMA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 006729274 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250425 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4004705 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541778786 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5417787860400E . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 233012 . This is a "MAMSI HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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