MEDICARE: DR. CAROL ANN GAGNON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	193228	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010193228	OTHER	NY	BLUE CHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	101484DL	OTHER	NY	PREFERRED CARE
4	3464	OTHER	NY	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1134272867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL ANN GAGNON M.D.

Provider Business Mailing Address
First Line	:	497 BEAHAN RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3403
Country	:	US
Telephone Number	:	585-247-5400
Fax Number	:	585-319-4124

Provider Business Practice Location Address
First Line	:	497 BEAHAN RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-3403
Country	:	US
Telephone Number	:	585-247-5400
Fax Number	:	585-319-4124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	06/30/2017

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