Provider Demographics
NPI:1922083518
Name:PAGANA & PAGANA-DEFAZIO FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:PAGANA & PAGANA-DEFAZIO FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAGANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-286-8521
Mailing Address - Street 1:1072 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2403
Mailing Address - Country:US
Mailing Address - Phone:570-286-8521
Mailing Address - Fax:570-286-6197
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50015382OtherCAPITAL BLUE CROSS
PA212152OtherHEALTH AMER/HEALTH ASSUR
PA1485124OtherKEYSTONE
PADA4198OtherPALMETTO
PA1485124OtherBLUE SHIELD
PA1485124OtherBLUE SHIELD