Provider Demographics
NPI:1376814293
Name:GAGNON ONCOLOGY, LLC
Entity Type:Organization
Organization Name:GAGNON ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-695-6555
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-0127
Mailing Address - Country:US
Mailing Address - Phone:301-695-6555
Mailing Address - Fax:301-695-7750
Practice Address - Street 1:501 W 7TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4586
Practice Address - Country:US
Practice Address - Phone:240-566-4500
Practice Address - Fax:301-695-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00399542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD758511000Medicaid
MD175725ZGABMedicare UPIN