Provider Demographics
NPI:1780676296
Name:LAGUERRE, MAX S (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:S
Last Name:LAGUERRE
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 1:4567 CROSSROADS PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:5 LYON PL
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-2586
Practice Address - Country:US
Practice Address - Phone:315-393-2314
Practice Address - Fax:315-393-3873
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2262302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02348805Medicaid
PA103210167Medicaid
NYJ400154103Medicare PIN
NYRA1465Medicare PIN
NY92007503Medicare PIN
NYE61642Medicare UPIN