Provider Demographics
NPI:1255325874
Name:PASTORE, JOHN O (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:O
Last Name:PASTORE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:RM 339
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-789-3149
Mailing Address - Fax:617-789-5029
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:DEPT OF CARDIOLOGY CCP4C
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-789-3149
Practice Address - Fax:617-789-5029
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-10-21
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Provider Licenses
StateLicense IDTaxonomies
MA35395207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2016117Medicaid
MA2016117Medicaid