Provider Demographics
NPI:1326052986
Name:KAGAN, LARRY HOWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:HOWARD
Last Name:KAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MRS
Other - First Name:KIMBERLEY
Other - Middle Name:KOONS
Other - Last Name:WOLOSHIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1016 JUSTIS ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325
Mailing Address - Country:US
Mailing Address - Phone:757-420-8297
Mailing Address - Fax:757-523-5639
Practice Address - Street 1:1016 JUSTIS ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325
Practice Address - Country:US
Practice Address - Phone:757-420-8297
Practice Address - Fax:757-523-5639
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5619165Medicaid
011785OtherANTHEM
11018OtherSENTARA
11018OtherSENTARA
VA5619165Medicaid