Provider Demographics
NPI:1912966011
Name:GAGNON, ALDEN G (MD)
Entity Type:Individual
Prefix:
First Name:ALDEN
Middle Name:G
Last Name:GAGNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-1807
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:23 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2712
Practice Address - Country:US
Practice Address - Phone:978-256-4121
Practice Address - Fax:978-250-3210
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA29255207R00000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA709837OtherTUFTS HEALTH PLAN
MA99390801OtherNETWORK HEALTH
NH60521OtherHEALTHSOURCE
MA20696OtherFALLON COMM HEALTH PLAN
MAB13017OtherBCBS
NH30006380Medicaid
MA0130249Medicaid
MA3000077OtherUNITED HEALTHCARE
MA64833OtherHARVARD PILGRIM
MA709837OtherTUFTS HEALTH PLAN
MA99390801OtherNETWORK HEALTH