Healthcare Provider Details

I. General information

NPI: 1801859509
Provider Name (Legal Business Name): KEITH RICHARD LAGNESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 WALLINGFORD ST
PITTSBURGH PA
15213-1711
US

IV. Provider business mailing address

4723 WALLINGFORD ST
PITTSBURGH PA
15213-1711
US

V. Phone/Fax

Practice location:
  • Phone: 412-719-7964
  • Fax:
Mailing address:
  • Phone: 412-719-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD065349L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: