Provider Demographics
NPI:1972830594
Name:LAGOMARSINO, FRED JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:JOHN
Last Name:LAGOMARSINO
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 96
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-0096
Mailing Address - Country:US
Mailing Address - Phone:903-654-2316
Mailing Address - Fax:903-874-5269
Practice Address - Street 1:74 SUNSET SHORES LANE
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:ME
Practice Address - Zip Code:04917
Practice Address - Country:US
Practice Address - Phone:903-654-2316
Practice Address - Fax:903-874-5269
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME006249174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty