Provider Demographics
NPI:1871541821
Name:LAGOSKY, SUZANNE (DO)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LAGOSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79088
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0088
Mailing Address - Country:US
Mailing Address - Phone:703-914-8000
Mailing Address - Fax:804-270-7264
Practice Address - Street 1:5213 HICKORY PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2617
Practice Address - Country:US
Practice Address - Phone:703-914-8000
Practice Address - Fax:703-642-3487
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037211208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC020682P25Medicare PIN
VAF60995Medicare UPIN
VA004671M70Medicare PIN