Provider Demographics
NPI:1508887878
Name:LAGOC, ANDRES R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:R
Last Name:LAGOC
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:RUBIN INSTITUTE FOR ADVANCED ORTHOPEDICS
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-9440
Practice Address - Fax:410-601-1870
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003101363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD164164ZC58Medicare PIN
MD956LMedicare PIN