MEDICARE: DR. JEFFREY PANTANO DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	2488	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295187300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY PANTANO DPM

Provider Business Mailing Address
First Line	:	100 HIGHLAND ST STE 122
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-3878
Country	:	US
Telephone Number	:	617-698-4830
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 HIGHLAND ST STE 122
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-3878
Country	:	US
Telephone Number	:	617-698-4830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	10/06/2025

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