Provider Demographics
NPI:1316996762
Name:LAGRADA, WILLIAM V (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:V
Last Name:LAGRADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15 FORSYTHIA DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3086
Mailing Address - Country:US
Mailing Address - Phone:732-549-3490
Mailing Address - Fax:732-617-8808
Practice Address - Street 1:203 ROUTE 9
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8270
Practice Address - Country:US
Practice Address - Phone:732-617-8800
Practice Address - Fax:732-617-8808
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA069932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1740345693Other741 BROADWAY
NJ25MA06993200OtherNJ LICENSE
NJ1194996645Other444 WILLIAM STREET
NJ0033855Medicaid
NJ0033855Medicaid
NJ1740345693Other741 BROADWAY
NJ25MA06993200OtherNJ LICENSE