Provider Demographics
NPI:1407811029
Name:PANDISCIO, MARION M (MD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:M
Last Name:PANDISCIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 59TH ST W
Mailing Address - Street 2:BLAKE PARK STE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-792-4993
Mailing Address - Fax:941-795-2905
Practice Address - Street 1:1850 59TH ST W
Practice Address - Street 2:BLAKE PARK STE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-792-4993
Practice Address - Fax:941-795-2905
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65466207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL160033444OtherRAILROAD MEDICARE
FL28174OtherBCBS
FLF52930Medicare UPIN
FL28174Medicare ID - Type Unspecified