Provider Demographics
NPI:1720035918
Name:LAGALLY, KARL H (DO)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:H
Last Name:LAGALLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9763 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1915
Mailing Address - Country:US
Mailing Address - Phone:540-786-1200
Mailing Address - Fax:540-710-2752
Practice Address - Street 1:9763 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1915
Practice Address - Country:US
Practice Address - Phone:540-786-1200
Practice Address - Fax:540-710-2752
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA183516OtherANTHEM SVS & HEALTHKEEPER
VA313081OtherSOUTHERN HEALTH
VA183516Medicaid
VA3803459OtherCIGNA
VA010187907Medicaid
VA183516OtherANTHEM SVS & HEALTHKEEPER
VA183516Medicaid
VA008943M21Medicare ID - Type UnspecifiedTRAILBLAZER HEALTHCARE