Provider Demographics
NPI:1376814293
Name:GAGNON ONCOLOGY, LLC
Entity type:Organization
Organization Name:GAGNON ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOSECCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-324-2340
Mailing Address - Street 1:111 LODER ST STE B
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1950
Mailing Address - Country:US
Mailing Address - Phone:888-465-5278
Mailing Address - Fax:607-324-7615
Practice Address - Street 1:1562 OPOSSUMTOWN PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4920
Practice Address - Country:US
Practice Address - Phone:240-566-4500
Practice Address - Fax:301-694-5554
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAGNON ONCOLOGY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-24
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00399542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD758511000Medicaid
MD175725ZGABMedicare UPIN