Basic Information
| Provider Information | |||||||||
| NPI: | 1003934613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAGNOTTO | ||||||||
| FirstName: | MARY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11279 PERRY HWY STE 450 | ||||||||
| Address2: | |||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150909303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249331100 | ||||||||
| FaxNumber: | 7249331160 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 CORAOPOLIS HEIGHTS RD STE E | ||||||||
| Address2: | |||||||||
| City: | MOON TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151084316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122622415 | ||||||||
| FaxNumber: | 4122621537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | MD431028 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 208000000X | MD431028 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.