Healthcare Provider Details

I. General information

NPI: 1093782807
Provider Name (Legal Business Name): LAWRENCE E GAGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HAGEN DR SUITE 100
ROCHESTER NY
14625-2658
US

IV. Provider business mailing address

30 HAGEN DR SUITE 100
ROCHESTER NY
14625-2658
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-2700
  • Fax: 585-242-9663
Mailing address:
  • Phone: 585-338-2700
  • Fax: 585-242-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number147475
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: