Provider Demographics
NPI:1962406355
Name:LAGMAN, DENNIS VELASGUEZ (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:VELASGUEZ
Last Name:LAGMAN
Suffix:
Gender:M
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 39413
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44139-0413
Mailing Address - Country:US
Mailing Address - Phone:440-523-5023
Mailing Address - Fax:440-523-5029
Practice Address - Street 1:10 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3460
Practice Address - Country:US
Practice Address - Phone:440-354-2400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-4212-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2074366Medicaid
G92870Medicare UPIN
OH2074366Medicaid