Provider Demographics
NPI:1568423341
Name:PAGANA, TIMOTHY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:PAGANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 GRAMPIAN BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1909
Practice Address - Country:US
Practice Address - Phone:570-326-8200
Practice Address - Fax:570-320-7540
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018499E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008611620002Medicaid
PA112452OtherUNITEDHEALTHCARE
PA50054304OtherCAPITAL BLUE CROSS
PA053838OtherHIGHMARK BLUE SHIELD
PA217848OtherAETNA
PA23097OtherGEISINGER HEALTH PLAN
PA815726OtherFIRST PRIORITY HEALTH
PAB34486OtherHEALTHAMERICA
PA020043915Medicare PIN
B34486Medicare UPIN