Provider Demographics
NPI:1144396060
Name:LAGORIO, MARY MICHELE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MICHELE
Last Name:LAGORIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11755 OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HOPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95449-2132
Mailing Address - Country:US
Mailing Address - Phone:707-972-5415
Mailing Address - Fax:707-744-3337
Practice Address - Street 1:11750 OLD RIVER RD
Practice Address - Street 2:
Practice Address - City:HOPLAND
Practice Address - State:CA
Practice Address - Zip Code:95449-2132
Practice Address - Country:US
Practice Address - Phone:707-972-5415
Practice Address - Fax:707-744-3337
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8741207R00000X
CA20A6812207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00471709OtherRR MEDICARE
FL57948OtherBCBS
FL99267OtherBC/BS
FL266515800Medicaid
FLP00204267OtherRAILROAD MEDICARE
FL291851OtherAVMED
H71028Medicare UPIN
57948ZMedicare Oscar/Certification
FL57948YMedicare PIN
FL266515800Medicaid