Provider Demographics
NPI:1629464151
Name:PAGANO, MATTHEW (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PAGANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MCFARLAN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2479
Mailing Address - Country:US
Mailing Address - Phone:610-925-3835
Mailing Address - Fax:610-925-3834
Practice Address - Street 1:404 MCFARLAN RD STE 101
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2479
Practice Address - Country:US
Practice Address - Phone:610-925-3835
Practice Address - Fax:610-925-3834
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021854207Q00000X
NY301783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine