Basic Information
| Provider Information | |||||||||
| NPI: | 1215902515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAGADOR | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7068 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237070068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576863539 | ||||||||
| FaxNumber: | 7576860230 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 GODWIN BLVD | ||||||||
| Address2: | STE 3 | ||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234348178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579239660 | ||||||||
| FaxNumber: | 7579239665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101231314 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 177420 | 01 | VA | ANTHEM | OTHER | 44444 | 01 | VA | SENTARA/OPTIMA | OTHER | 7221365 | 01 | VA | AETNA | OTHER |