Provider Demographics
NPI:1386901684
Name:GAGNON, AMY LENFESTEY (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LENFESTEY
Last Name:GAGNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16536
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6536
Mailing Address - Country:US
Mailing Address - Phone:919-653-1344
Mailing Address - Fax:
Practice Address - Street 1:110 PRESTON EXECUTIVE DR STE 108
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8447
Practice Address - Country:US
Practice Address - Phone:919-653-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260451207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology