Provider Demographics
NPI:1215902515
Name:PAGADOR, JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PAGADOR
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:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3539
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:2401 GODWIN BLVD
Practice Address - Street 2:STE 3
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8178
Practice Address - Country:US
Practice Address - Phone:757-923-9660
Practice Address - Fax:757-923-9665
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA177420OtherANTHEM
VA44444OtherSENTARA/OPTIMA
VA7221365OtherAETNA
VAG53408Medicare UPIN
VA007778B28Medicare ID - Type Unspecified