Provider Demographics
NPI:1700884095
Name:PAGAN, MARY E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:PAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:670 LAWN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1571
Mailing Address - Country:US
Mailing Address - Phone:215-257-0414
Mailing Address - Fax:215-257-1740
Practice Address - Street 1:670 LAWN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1571
Practice Address - Country:US
Practice Address - Phone:215-257-0414
Practice Address - Fax:215-257-1740
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD049796L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100769OtherOTHER BS
PA0015793070002Medicaid
0994912000OtherINDEPENDENCE BS
1094218OtherOTHER HMO
541601OtherAETNA
PAF57906Medicare UPIN
PA746290FC3Medicare ID - Type Unspecified