Provider Demographics
NPI:1740286715
Name:PANDISCIO, JOHN N (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:PANDISCIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:169 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2175
Mailing Address - Country:US
Mailing Address - Phone:508-435-6903
Mailing Address - Fax:508-435-2311
Practice Address - Street 1:169 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-2175
Practice Address - Country:US
Practice Address - Phone:508-435-6903
Practice Address - Fax:508-435-2311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA0044953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0074053002OtherCIGNA
MA4692OtherFALLON
MA2000000364OtherHARVID PILGRIM HEALTH CAR
MA6193358Medicaid
MA709859OtherTUFTS HEALTH PLAN
MA0102037OtherUNITED HEALTHCARE
MAJ04562OtherBLUE CROSS& BLUE SHIELD
MAJ04562OtherBLUE CROSS& BLUE SHIELD
MAAP3083514OtherDEA #
MA0102037OtherUNITED HEALTHCARE