Provider Demographics
NPI:1811233612
Name:GAGNON, ADAM MATTHEW
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:MATTHEW
Last Name:GAGNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CORY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2812
Mailing Address - Country:US
Mailing Address - Phone:774-644-1919
Mailing Address - Fax:
Practice Address - Street 1:259 SAMUEL BARNET BLVD
Practice Address - Street 2:UNIT 2
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-1214
Practice Address - Country:US
Practice Address - Phone:508-995-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator