Provider Demographics
NPI:1528003522
Name:PAGANO, TOM V (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:V
Last Name:PAGANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:816 22ND AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2226
Mailing Address - Country:US
Mailing Address - Phone:308-865-2808
Mailing Address - Fax:308-865-2541
Practice Address - Street 1:3219 CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68848-0550
Practice Address - Country:US
Practice Address - Phone:308-865-2808
Practice Address - Fax:308-865-2541
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE15146207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE281520Medicare PIN
E73935Medicare UPIN