Provider Demographics
NPI:1003873241
Name:GAGNE, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:GAGNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 AUTUMN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1301
Mailing Address - Country:US
Mailing Address - Phone:724-375-3199
Mailing Address - Fax:724-375-5858
Practice Address - Street 1:274 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2333
Practice Address - Country:US
Practice Address - Phone:724-774-5700
Practice Address - Fax:724-774-5175
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD053735L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015218350003Medicaid
OH0144016Medicaid
PA786537OtherBLUE SHIELD
PA204249OtherUPMC
OH0144016Medicaid
PA0015218350003Medicaid