Provider Demographics
NPI:1093458820
Name:PAGADUAN, PATRICK NICHOLEUS CAMPO (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:NICHOLEUS CAMPO
Last Name:PAGADUAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EXECUTIVE DR STE H
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4155
Mailing Address - Country:US
Mailing Address - Phone:434-791-1345
Mailing Address - Fax:434-773-6811
Practice Address - Street 1:125 EXECUTIVE DR STE H
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4155
Practice Address - Country:US
Practice Address - Phone:434-791-1345
Practice Address - Fax:434-773-6811
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0116036872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program