Provider Demographics
NPI:1467624676
Name:RICHARD G. GAGNIER, MD
Entity Type:Organization
Organization Name:RICHARD G. GAGNIER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAGNIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-244-4510
Mailing Address - Street 1:900 WINTON RD S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1628
Mailing Address - Country:US
Mailing Address - Phone:585-244-4510
Mailing Address - Fax:585-244-1695
Practice Address - Street 1:900 WINTON RD S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1628
Practice Address - Country:US
Practice Address - Phone:585-244-4510
Practice Address - Fax:585-244-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60136454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW52264OtherMEDICARE PTAN GROUP
NY00714618Medicaid
NYW52264OtherMEDICARE PTAN GROUP
NY00714618Medicaid
NY=========OtherTAX IDENTIFICATION NUMBER