MEDICARE: GREGORY GAGNON

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	2085R0001X	Radiation Oncology Physician	D39954	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407854268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY GAGNON

Provider Business Mailing Address
First Line	:	111 LODER ST
Second Line	:
City	:	HORNELL
State	:	NY
Zip	:	14843-1950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1562 OPOSSUMTOWN PIKE
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4337
Country	:	US
Telephone Number	:	240-566-4500
Fax Number	:	301-694-5554

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/30/2023

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