Provider Demographics
NPI:1952379315
Name:PAJEL-SIO, MARY ANNE AGOO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:AGOO
Last Name:PAJEL-SIO
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 1:855 DORSET CT N
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3436
Mailing Address - Country:US
Mailing Address - Phone:908-619-0412
Mailing Address - Fax:
Practice Address - Street 1:2551 BAGLYOS CIRCLE A-10
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8056
Practice Address - Country:US
Practice Address - Phone:610-866-4201
Practice Address - Fax:610-866-9590
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066578L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07611205Medicaid
PA2323984OtherAETNA PROVIDER
PA0172113OtherINDEP BLUE CROSS
PA02354900OtherCAPITAL BLUE CROSS
PA182055OtherHIGHMARK BLUE SHIELD
PA182055OtherHIGHMARK BLUE SHIELD
PA0172113OtherINDEP BLUE CROSS