Provider Demographics
NPI:1336158328
Name:PAGANO, TERRI D (PA)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:D
Last Name:PAGANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 WEBSTER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2557
Mailing Address - Country:US
Mailing Address - Phone:510-841-8700
Mailing Address - Fax:510-295-2651
Practice Address - Street 1:2510 WEBSTER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2557
Practice Address - Country:US
Practice Address - Phone:510-841-8700
Practice Address - Fax:510-295-2651
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18304363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1071096OtherNATL COMMISSION ON CERTIF
MP1389673OtherDEA #
CABL914ZMedicare PIN
CA0PA183040Medicare PIN