Provider Demographics
NPI:1114013554
Name:JAGDEO, CAROL CHRISTINE (MD)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:CHRISTINE
Last Name:JAGDEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 IRVING STREET, NW
Mailing Address - Street 2:SUITE 406 SOUTH
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2931
Mailing Address - Country:US
Mailing Address - Phone:202-877-0535
Mailing Address - Fax:202-877-9088
Practice Address - Street 1:106 IRVING STREET, NW
Practice Address - Street 2:SUITE 406 S
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2931
Practice Address - Country:US
Practice Address - Phone:202-877-0535
Practice Address - Fax:202-877-9088
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD14312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC342017092Medicare PIN
490859Medicare ID - Type Unspecified
DCB94334Medicare UPIN