1952379315 NPI number — DR. MARY ANNE AGOO PAJEL-SIO M.D.

Table of content: DR. MARY ANNE AGOO PAJEL-SIO M.D. (NPI 1952379315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952379315 NPI number — DR. MARY ANNE AGOO PAJEL-SIO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAJEL-SIO
Provider First Name:
MARY ANNE
Provider Middle Name:
AGOO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952379315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
855 DORSET CT N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18104-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-619-0412
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2551 BAGLYOS CIRCLE A-10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18020-8056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-866-4201
Provider Business Practice Location Address Fax Number:
610-866-9590
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD066578L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07611205 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2323984 . This is a "AETNA PROVIDER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0172113 . This is a "INDEP BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02354900 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 182055 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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