Basic Information
Provider Information
NPI: 1003143033
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAGNIER
FirstName: JAMES
MiddleName: MICHAEL
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 61 MONROE AVE
Address2: SUITE B
City: PITTSFORD
State: NY
PostalCode: 145341311
CountryCode: US
TelephoneNumber: 5855865166
FaxNumber:  
Practice Location
Address1: 61 MONROE AVE
Address2: SUITE B
City: PITTSFORD
State: NY
PostalCode: 145341311
CountryCode: US
TelephoneNumber: 5855865166
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/12/2009
LastUpdateDate: 11/13/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZD0900XD39437MDY Allopathic & Osteopathic PhysiciansPathologyDermatopathology

No ID Information.


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