Provider Demographics
NPI:1285698787
Name:DRAGOON, NANCY ANN
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ANN
Last Name:DRAGOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:SUITE 370 NORTH
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1200
Mailing Address - Country:US
Mailing Address - Phone:508-363-7300
Mailing Address - Fax:508-363-9688
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 370 NORTH
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1200
Practice Address - Country:US
Practice Address - Phone:508-363-7300
Practice Address - Fax:508-363-9688
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110175131OtherRR MEDICARE
MA7248066004OtherCIGNA
MA3022307Medicaid
MA3052316OtherCIGNA HEALTHSOURCE
MD0400903OtherEVERCARE
MA3052316OtherCIGNA HEALTHSOURCE
MA7248066004OtherCIGNA