David R Gagnon, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

7236 Issued in NH

Practice address

100 Campus Dr Ste 12
Portsmouth, NH 03801-5892

Phone

(603) 422-8208

Fax

(603) 422-8218

NPI assigned

May 26, 2006

Reactivated

Oct 23, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1831145259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 ROUTE 108",
            "address_2": "BUSINESS OFFICE",
            "city": "SOMERSWORTH",
            "state": "NH",
            "postal_code": "038781522",
            "telephone_number": "603-749-2346",
            "fax_number": "603-953-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CAMPUS DR STE 12",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038015892",
            "telephone_number": "603-422-8208",
            "fax_number": "603-422-8218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19 Levesque Drive",
            "address_2": "Suite 2",
            "address_purpose": "LOCATION",
            "city": "Eliot",
            "state": "ME",
            "postal_code": "039032079",
            "country_code": "US",
            "telephone_number": "207-451-9600",
            "fax_number": "207-451-9603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "DAVID",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2021-08-18",
        "certification_date": "2021-07-28",
        "deactivation_date": "2011-09-23",
        "reactivation_date": "2013-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "12177",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "7236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30001207",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "239030099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Further Care P a
• Kelsey M Fusco, MS
• Leila Fussell
• Lindsey M Gagne, OTR/L
• Michelle Gagne, MSW
• Elyse Gallo, OTR/L
• Kendall Galvin
• Watcharee Amornpairoj Galvin, MD, MS
• Sophia Francesca Gamez, MD
• Jennifer M Gandolfo

• Family Medicine Physician in Portsmouth, NH
• Providers in Portsmouth, NH by specialty
• Family Medicine Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.