Provider Demographics
NPI:1811954977
Name:NAGLE, LAWRENCE S (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
Last Name:NAGLE
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 1:979 E 3RD ST
Mailing Address - Street 2:STE A0540-A0550
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-752-5004
Mailing Address - Fax:423-756-9009
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:STE A0540-A0550
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-752-5004
Practice Address - Fax:423-756-9009
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0017696207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3083473Medicaid
BN0993039OtherDEA
A99646Medicare UPIN
3032855Medicare ID - Type Unspecified