Provider Demographics
NPI:1487654711
Name:LAGAN, JANE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:R
Last Name:LAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0347
Mailing Address - Country:US
Mailing Address - Phone:570-288-8881
Mailing Address - Fax:570-288-8065
Practice Address - Street 1:241 CLAREMONT AVENUE
Practice Address - Street 2:
Practice Address - City:HOMETOWN
Practice Address - State:PA
Practice Address - Zip Code:18252-4433
Practice Address - Country:US
Practice Address - Phone:570-225-7211
Practice Address - Fax:570-225-7221
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD042458L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1247479Medicaid
PAMD042458LOtherSTATE MEDICAL LICENSE
PAF05179Medicare UPIN
PA1247479Medicaid