Provider Demographics
NPI:1699799668
Name:PAGANO, MICHAEL P (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:PAGANO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HOLLY HILL LN
Mailing Address - Street 2:OCCUPATIONAL HEALTH, GREENWICH HOSPITAL
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6098
Mailing Address - Country:US
Mailing Address - Phone:203-863-3400
Mailing Address - Fax:203-863-3495
Practice Address - Street 1:75 HOLLY HILL LN
Practice Address - Street 2:OCCUPATIONAL HEALTH, GREENWICH HOSPITAL
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6098
Practice Address - Country:US
Practice Address - Phone:203-863-3400
Practice Address - Fax:203-863-3495
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P26549Medicare UPIN
CT970002087Medicare ID - Type Unspecified