Provider Demographics
NPI:1346570884
Name:PAKEMAN-MAURO, JASON (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PAKEMAN-MAURO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:NEUROSCIENCE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-1544
Mailing Address - Fax:410-601-1543
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:NEUROSCIENCE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-1544
Practice Address - Fax:410-601-1543
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS576Medicare PIN
MDS567Medicare PIN
MD172446Y4HMedicare PIN
MD172446Y0UMedicare PIN