Provider Demographics
NPI:1437763562
Name:LAGOS, CHAD (RT(R)(CT) CIIP MSHI)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:LAGOS
Suffix:
Gender:M
Credentials:RT(R)(CT) CIIP MSHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-5360
Mailing Address - Country:US
Mailing Address - Phone:304-663-7818
Mailing Address - Fax:
Practice Address - Street 1:71 RIDGE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-5360
Practice Address - Country:US
Practice Address - Phone:304-663-7818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54622471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography