MEDICARE: MARK A. LAGATTA 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	207RN0300X	Nephrology Physician	ME0073930	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	390007737	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42654	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	276417	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1821081985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A. LAGATTA M.D.

Provider Business Mailing Address
First Line	:	807 S ORLANDO AVE
Second Line	:	SUITE C
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4870
Country	:	US
Telephone Number	:	407-894-4693
Fax Number	:	407-539-0469

Provider Business Practice Location Address
First Line	:	4100 METRIC DR
Second Line	:	SUITE 200
City	:	WINTER PARK
State	:	FL
Zip	:	32792-6832
Country	:	US
Telephone Number	:	407-681-8720
Fax Number	:	407-681-8729

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	12/23/2009

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Directions to “ MARK A. LAGATTA M.D.” Practice Location

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