Provider Demographics
NPI:1881680817
Name:PAGANA, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
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 1:1072 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2458
Mailing Address - Country:US
Mailing Address - Phone:570-743-8282
Mailing Address - Fax:
Practice Address - Street 1:1072 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2403
Practice Address - Country:US
Practice Address - Phone:570-286-8521
Practice Address - Fax:570-286-6197
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014320E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006111600002Medicaid
PA50015380OtherCAPITAL BLUE CROSS
PAP00058273OtherPALMETTO
PA017192700OtherBLACK LUNG
PA162618OtherPA. BLUE SHIELD
PA017192700OtherBLACK LUNG
PA162618R2QMedicare ID - Type Unspecified