MEDICARE: SUZANNE LAGOSKY 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	208VP0000X	Pain Medicine Physician	0102037211	VA
2	208VP0014X	Interventional Pain Medicine Physician	0102037211	VA

General Provider Information

NPI Number	:	1871541821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE LAGOSKY DO

Provider Business Mailing Address
First Line	:	PO BOX 79088
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-0088
Country	:	US
Telephone Number	:	703-914-8000
Fax Number	:	804-270-7264

Provider Business Practice Location Address
First Line	:	5213 HICKORY PARK DR
Second Line	:	SUITE B
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2617
Country	:	US
Telephone Number	:	703-914-8000
Fax Number	:	703-642-3487

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/12/2016

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