Provider Demographics
NPI:1942206883
Name:PANSINO, TERRENCE L (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:L
Last Name:PANSINO
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 1:3515 MASSILLON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6400
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:1917 WILLIAMSBURG WAY NE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-8781
Practice Address - Country:US
Practice Address - Phone:330-875-3366
Practice Address - Fax:330-875-1106
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-3559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0628155Medicaid
OH0584753OtherMEDICARE PTAN
OHA16486Medicare UPIN