Provider Demographics
NPI:1528045812
Name:EUGENE C. JAGELLA, M.D. PC
Entity Type:Organization
Organization Name:EUGENE C. JAGELLA, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAGELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-478-4618
Mailing Address - Street 1:PO BOX 9132
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-9132
Mailing Address - Country:US
Mailing Address - Phone:603-893-9784
Mailing Address - Fax:603-893-8886
Practice Address - Street 1:40 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3026
Practice Address - Country:US
Practice Address - Phone:508-478-4618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM19099OtherBCBS MASS
MA9765140Medicaid
MA9765140Medicaid