Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | I3-0001187 | DE |
Y | 152W00000X | Optometrist | OEG001178 | PA |
NPI | 1013008226 |
---|---|
Provider Name | Dr. Jean Marie Pagani |
First Address | Media, PA 19063-6318 |
Second Address | Philadelphia, PA 19141-3323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 04/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00061991 | RAILROAD MEDICARE (01) | PA |
0011944190003 | (05) | PA |
0115840000 | KHPE (01) | PA |
2248 | AETNA HMO (01) | PA |
539951 | BLUE SHIELD (01) | PA |
U08264 | (02) | PA |