Provider Demographics
NPI:1174746952
Name:J EDWARD DAGEN MD PC
Entity type:Organization
Organization Name:J EDWARD DAGEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-245-0131
Mailing Address - Street 1:9 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-9126
Mailing Address - Country:US
Mailing Address - Phone:717-245-0131
Mailing Address - Fax:717-245-9611
Practice Address - Street 1:9 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-9126
Practice Address - Country:US
Practice Address - Phone:717-245-0131
Practice Address - Fax:717-245-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017601E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9390390OtherCIGNA
PA095786OtherBLUE SHIELD
PA03250401OtherCAPITAL BLUE CROSS
PA0007397920002Medicaid
PA527353OtherAETNA
PA095786OtherBLUE SHIELD
PA0007397920002Medicaid