Basic Information
| Provider Information | |||||||||
| NPI: | 1407811029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANDISCIO | ||||||||
| FirstName: | MARION | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 59TH ST W | ||||||||
| Address2: | BLAKE PARK STE B | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417924993 | ||||||||
| FaxNumber: | 9417952905 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 59TH ST W | ||||||||
| Address2: | BLAKE PARK STE B | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417924993 | ||||||||
| FaxNumber: | 9417952905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | ME65466 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 160033444 | 01 | FL | RAILROAD MEDICARE | OTHER | 28174 | 01 | FL | BCBS | OTHER |