Provider Demographics
NPI:1487662920
Name:LAGRAVE, BRENT F (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:F
Last Name:LAGRAVE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1450 WESTERN AVE STE 102
Mailing Address - Street 2:ANESTHESIA GROUP OF ALBANY, PC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3539
Mailing Address - Country:US
Mailing Address - Phone:518-463-0050
Mailing Address - Fax:518-207-2973
Practice Address - Street 1:1450 WESTERN AVE STE 102
Practice Address - Street 2:ANESTHESIA GROUP OF ALBANY, PC
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3539
Practice Address - Country:US
Practice Address - Phone:518-463-0050
Practice Address - Fax:518-207-2973
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-05-24
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Provider Licenses
StateLicense IDTaxonomies
NY240585207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB8842Medicare UPIN