Individual
JILL LAGEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
(860) 271-4224
Mailing address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
(860) 271-4224
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000208
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06-0646704
TRICARE
—
05
—
4014679
—
CT
05
—
4024972
—
CT
Enumeration date
09/06/2006
Last updated
01/30/2015
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