MEDICARE: DR. MARY MICHELE LAGORIO DO

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	207R00000X	Internal Medicine Physician	OS8741	FL
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	20A6812	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00471709	OTHER	FL	RR MEDICARE
5	P00204267	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	57948	OTHER	FL	BCBS
3	99267	OTHER	FL	BC/BS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	291851	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1144396060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY MICHELE LAGORIO DO

Provider Business Mailing Address
First Line	:	11755 OLD RIVER RD
Second Line	:
City	:	HOPLAND
State	:	CA
Zip	:	95449-2132
Country	:	US
Telephone Number	:	707-972-5415
Fax Number	:	707-744-3337

Provider Business Practice Location Address
First Line	:	11750 OLD RIVER RD
Second Line	:
City	:	HOPLAND
State	:	CA
Zip	:	95449-2132
Country	:	US
Telephone Number	:	707-972-5415
Fax Number	:	707-744-3337

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	12/12/2022

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Directions to “ DR. MARY MICHELE LAGORIO DO” Practice Location

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