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Individual

DAVID A DAGEFORDE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3901 DUTCHMANS LN STE 101, LOUISVILLE, KY 40207-4726
(502) 896-2120
(502) 896-2110
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 272-5395
(502) 272-5339

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
20071
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000044911
ANTHEM PIN
KY
01
000000693027
ANTHEM - NCVA
KY
01
000057080C
HUMANA - NCVA
KY
01
0203578000
PASSPORT ADVANAGE PIN
KY
01
060018530
RAILROAD MEDICARE PIN
KY
05
100388760A
IN
05
100388760F
IN
01
1056110
PASSPORT PIN
KY
01
50031154
PASSPORT & PASSPORT ADVTG - NCVA
KY
05
64200710
KY
01
P00889587
MEDICARE RR - NCVA
KY
Enumeration date
06/27/2006
Last updated
05/04/2021
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