Provider Demographics
NPI:1821081985
Name:LAGATTA, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:LAGATTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:807 S ORLANDO AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4870
Mailing Address - Country:US
Mailing Address - Phone:407-894-4693
Mailing Address - Fax:407-539-0469
Practice Address - Street 1:4100 METRIC DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6832
Practice Address - Country:US
Practice Address - Phone:407-681-8720
Practice Address - Fax:407-681-8729
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2009-12-23
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Provider Licenses
StateLicense IDTaxonomies
FLME0073930207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42654OtherBCBS
FL260724700Medicaid
FL276417OtherAVMED
FL390007737OtherRAILROAD MEDICARE
FL42654OtherBCBS
FL390007737OtherRAILROAD MEDICARE
FL276417OtherAVMED