Provider Demographics
NPI:1851388029
Name:KAGAN, JOSEPH P (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:KAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 PEARL ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2864
Mailing Address - Country:US
Mailing Address - Phone:508-897-6040
Mailing Address - Fax:508-897-6045
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2864
Practice Address - Country:US
Practice Address - Phone:508-897-6040
Practice Address - Fax:508-897-6045
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA49610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0164429Medicaid
MAJ03227Medicare ID - Type Unspecified
MA0164429Medicaid