Provider Demographics
NPI:1184465957
Name:JAGEMAN NAD JAGEMAN MDS INC
Entity type:Organization
Organization Name:JAGEMAN NAD JAGEMAN MDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-392-2745
Mailing Address - Street 1:6002 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-3220
Mailing Address - Country:US
Mailing Address - Phone:814-392-2745
Mailing Address - Fax:
Practice Address - Street 1:4108 ZUCK RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4539
Practice Address - Country:US
Practice Address - Phone:814-392-2745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty