Healthcare Provider Details

I. General information

NPI: 1689623902
Provider Name (Legal Business Name): HARVEY JAY KAGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 KEMPSVILLE RD SUITE 200
NORFOLK VA
23502-3800
US

IV. Provider business mailing address

885 KEMPSVILLE RD SUITE 200
NORFOLK VA
23502-3800
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-6342
  • Fax: 757-963-6158
Mailing address:
  • Phone: 757-461-6342
  • Fax: 757-963-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101026429
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: