Provider Demographics
NPI:1629153051
Name:AGEE, CECIL COE (MD)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:COE
Last Name:AGEE
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 1:28 MALCOLM RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3427
Mailing Address - Country:US
Mailing Address - Phone:617-524-9707
Mailing Address - Fax:
Practice Address - Street 1:28 MALCOLM RD
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3427
Practice Address - Country:US
Practice Address - Phone:617-524-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3019926Medicaid
MA3019926Medicaid