Organization
MARY JANE LAGREW, M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY J LAGREW M.D. (OWNER)
(859) 277-7920
Entity
Organization
Contact information
Practice address
1780 NICHOLASVILLE RD, SUITE 203, LEXINGTON, KY 40503-1400
(859) 277-7920
(859) 278-9279
Mailing address
1780 NICHOLASVILLE RD, SUITE 203, LEXINGTON, KY 40503-1400
(859) 277-7920
(859) 278-9279
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
20177
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64201775
—
KY
Enumeration date
11/18/2008
Last updated
11/18/2008
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