Healthcare Provider Details

I. General information

NPI: 1750305553
Provider Name (Legal Business Name): DAVID MARK KAGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 BELMONT ST
BROCKTON MA
02301-4436
US

IV. Provider business mailing address

1810 BEACON ST
BROOKLINE MA
02445-2004
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-3162
  • Fax:
Mailing address:
  • Phone: 617-739-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number77023
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number77023
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: