Provider Demographics
NPI:1982728101
Name:JOHN A PAGNOZZI MD LLC
Entity Type:Organization
Organization Name:JOHN A PAGNOZZI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGNOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-887-6753
Mailing Address - Street 1:86 NEW LONDON TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-887-6753
Mailing Address - Fax:
Practice Address - Street 1:86 NEW LONDON TURNPIKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-887-6753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001283960Medicaid
CT004245537Medicaid
CT020001605Medicare ID - Type Unspecified
CT004245537Medicaid