Provider Demographics
NPI:1003934613
Name:PAGNOTTO, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PAGNOTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11279 PERRY HWY STE 450
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9303
Mailing Address - Country:US
Mailing Address - Phone:724-933-1100
Mailing Address - Fax:724-933-1160
Practice Address - Street 1:1600 CORAOPOLIS HEIGHTS RD STE E
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4316
Practice Address - Country:US
Practice Address - Phone:412-262-2415
Practice Address - Fax:412-262-1537
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2021-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4310282080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine