Provider Demographics
NPI:1811103609
Name:PAGANO, TERESA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:JANE
Last Name:PAGANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 W LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-9820
Mailing Address - Country:US
Mailing Address - Phone:315-655-2606
Mailing Address - Fax:
Practice Address - Street 1:7432 COUNTY HOUSE RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-8216
Practice Address - Country:US
Practice Address - Phone:315-258-2174
Practice Address - Fax:315-258-2105
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1269262084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry