Provider Demographics
NPI:1922074475
Name:PAGAN, NOEMI R (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEMI
Middle Name:R
Last Name:PAGAN
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:16 WINDERMERE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7412
Practice Address - Country:US
Practice Address - Phone:843-766-9053
Practice Address - Fax:843-766-8853
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238238207Q00000X
SC28816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC288165Medicaid
SCP00727223OtherRAILROAD MEDICARE ID-RSFPN
SCAA2008Medicare UPIN
SCAA20089223Medicare PIN
SC288165Medicaid
SCAA20087819Medicare PIN
SCAA20087126Medicare PIN