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General NPI Number Information
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NPI Number | 1740500198
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Entity Type | Organization
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Legal Business Name | CHESTNUT HILL PULMONARY, LLC
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 8815 GERMANTOWN AVE SUITE 12
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2722
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Country | US
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Telephone | 215-247-8070
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Fax |
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Provider Business Mailing Address
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Address Line | 109 SAWGRASS DR
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City | BLUE BELL
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State | PA
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Zip | 19422-3209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MICHAEL S LAGNESE
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Credential | D.O.
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Telephone | 215-837-5855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | OS008616L
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License Number State | PA
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