Provider Demographics
NPI:1003126483
Name:PANDISCIA, JOSEPH D (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:PANDISCIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:PANDISCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 8360
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-1360
Mailing Address - Country:US
Mailing Address - Phone:340-714-2845
Mailing Address - Fax:340-714-2843
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-475-8690
Practice Address - Fax:513-475-7257
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006730363A00000X
OH50005815RX363A00000X
363A00000X
CAPA54482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant