Healthcare Provider Details

I. General information

NPI: 1952380388
Provider Name (Legal Business Name): JAMES C LAGRUA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 LEE HWY
VERONA VA
24482
US

IV. Provider business mailing address

140 PROVIDENCE LN
WAYNESBORO VA
22980-9432
US

V. Phone/Fax

Practice location:
  • Phone: 540-248-3413
  • Fax: 540-248-8413
Mailing address:
  • Phone: 540-887-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102-049998
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: