Provider Demographics
NPI:1851369714
Name:KAGAN, RICHARD JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JEFFREY
Last Name:KAGAN
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:PO BOX 8500 LOCK BOX #8302
Mailing Address - Street 2:SHRINERS HOSPITAL FOR CHILDREN
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-8302
Mailing Address - Country:US
Mailing Address - Phone:813-281-8487
Mailing Address - Fax:813-281-8113
Practice Address - Street 1:3229 BURNET AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3095
Practice Address - Country:US
Practice Address - Phone:513-872-6206
Practice Address - Fax:513-872-6396
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-056534208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0693692Medicaid
KY64860018Medicaid
OHA17320Medicare UPIN
OH0612444Medicare PIN