Provider Demographics
NPI:1457560054
Name:PAGANO, MARC ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ROBERT
Last Name:PAGANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11528 ROYALTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4469
Mailing Address - Country:US
Mailing Address - Phone:440-582-3310
Mailing Address - Fax:440-582-3310
Practice Address - Street 1:11528 ROYALTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4469
Practice Address - Country:US
Practice Address - Phone:440-582-3310
Practice Address - Fax:440-582-3310
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3320103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0674453Medicaid
OH160013OtherVALUE OPTIONS
OH341485124OtherMEDICAL MUTUAL OF OHIO
OH0674453Medicaid
OH341485124OtherMEDICAL MUTUAL OF OHIO