Provider Demographics
NPI:1760472831
Name:GAGON, ELEANOR LAW (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:LAW
Last Name:GAGON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELEANOR
Other - Middle Name:SMITH
Other - Last Name:LAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1716
Mailing Address - Country:US
Mailing Address - Phone:804-734-9942
Mailing Address - Fax:877-874-1008
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9942
Practice Address - Fax:877-874-1008
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010393162084P0800X
GA0200482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry