Gagarin, Andrey
Gagarin, Andrey is an sole proprietor health care provider with primary practice located at 680 Centre St , Brockton MA 02302-3308. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Gagarin, Andrey can be contacted via phone (508) 941-7228.Contact Information
Primary practice address
680 Centre St
Brockton MA 02302-3308
Phone: (508) 941-7228
Fax: (508) 941-6401
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 154838 | Massachusetts |
Profile Details
| NPI number | 1225074123 |
|---|---|
| LBN Legal business name | Gagarin, Andrey |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 21st, 2006 |
| Last updated | Dec 7th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225074123 | NPPES |
| Massachusetts | MEDICAID | 1200283 |
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