Provider Demographics
NPI:1306839048
Name:PANDO, JOSE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:PANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20268 PLANTATIONS RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4622
Mailing Address - Country:US
Mailing Address - Phone:302-644-2633
Mailing Address - Fax:302-644-9192
Practice Address - Street 1:20268 PLANTATIONS RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4622
Practice Address - Country:US
Practice Address - Phone:302-644-2633
Practice Address - Fax:302-644-9192
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004876207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G265988Medicare UPIN
00A752R45Medicare ID - Type Unspecified