Basic Information
| Provider Information | |||||||||
| NPI: | 1700884095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAGAN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 LAWN AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152570414 | ||||||||
| FaxNumber: | 2152571740 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 LAWN AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152570414 | ||||||||
| FaxNumber: | 2152571740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207V00000X | MD049796L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 100769 | 01 | OTHER BS | OTHER | 0015793070002 | 05 | PA | MEDICAID | 0994912000 | 01 | INDEPENDENCE BS | OTHER | 1094218 | 01 | OTHER HMO | OTHER | 541601 | 01 | AETNA | OTHER |