Basic Information
| Provider Information | |||||||||
| NPI: | 1548607955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANCIO | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MEADE | ||||||||
| OtherFirstName: | BROOKE | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 104 SELMA DR | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226013834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406782853 | ||||||||
| FaxNumber: | 5406782859 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 SOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH LAKE TAHOE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 96150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305435623 | ||||||||
| FaxNumber: | 5305415738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2013 | ||||||||
| LastUpdateDate: | 07/08/2019 | ||||||||
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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 | 207Q00000X | A155782 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.