Provider Demographics
NPI:1689623902
Name:KAGAN, HARVEY JAY (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:JAY
Last Name:KAGAN
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 1:885 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3800
Mailing Address - Country:US
Mailing Address - Phone:757-461-6342
Mailing Address - Fax:757-963-6158
Practice Address - Street 1:885 KEMPSVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-461-6342
Practice Address - Fax:757-963-6158
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026429208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
13261OtherOPTIMA HEALTH PLAN
VA006729274Medicaid
250425OtherANTHEM BCBS
4004705OtherAETNA
541778786OtherUNITED HEALTH CARE
5417787860400EOtherCIGNA HEALTH CARE
233012OtherMAMSI HEALTH PLAN
13261OtherOPTIMA HEALTH PLAN