Provider Demographics
NPI:1649433913
Name:LAGOY, CHARLES THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:LAGOY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2010
Mailing Address - Country:US
Mailing Address - Phone:406-293-3755
Mailing Address - Fax:
Practice Address - Street 1:186 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-8537
Practice Address - Country:US
Practice Address - Phone:802-334-3520
Practice Address - Fax:802-334-3512
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1025147Medicaid
VTY400235929OtherMEDICARE