Provider Demographics
NPI:1942307087
Name:PARDO, JUAN MANUEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MANUEL
Last Name:PARDO
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 1:2002 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-3900
Mailing Address - Fax:410-266-9245
Practice Address - Street 1:2002 MEDICAL PARKWAY
Practice Address - Street 2:SUITE 230
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-3900
Practice Address - Fax:410-266-9245
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD09163207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD027921800Medicaid
D74456Medicare UPIN
MD6687Medicare ID - Type Unspecified