Provider Demographics
NPI:1558313551
Name:DAGEN, J EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:EDWARD
Last Name:DAGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0854
Mailing Address - Country:US
Mailing Address - Phone:800-233-4082
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:800-233-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017601E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9390390OtherCIGNA
PA2801OtherHEALTH AMERICA/ASSURANCE
PA527353OtherAETNA
PA991660OtherKEYSTONE
PA095786OtherBLUE SHIELD
PA0007397920002Medicaid
PA03250401OtherCAPITAL BLUE CROSS
PA0007397920002Medicaid
PA095786OtherBLUE SHIELD