Provider Demographics
NPI:1205809597
Name:PAVIGLIANITI, JOSEPH CARMINE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CARMINE
Last Name:PAVIGLIANITI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2201 CHARLES ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3378
Mailing Address - Country:US
Mailing Address - Phone:540-681-1211
Mailing Address - Fax:540-681-1544
Practice Address - Street 1:2201 CHARLES ST STE 103
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3378
Practice Address - Country:US
Practice Address - Phone:540-681-1211
Practice Address - Fax:540-681-1544
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423479207W00000X, 207WX0110X
VA0101279927207WX0110X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101195689Medicaid
PA084515E8NMedicare ID - Type Unspecified