Healthcare Provider Details

I. General information

NPI: 1740286715
Provider Name (Legal Business Name): JOHN N PANDISCIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 W MAIN ST
HOPKINTON MA
01748-2175
US

IV. Provider business mailing address

169 W MAIN ST
HOPKINTON MA
01748-2175
US

V. Phone/Fax

Practice location:
  • Phone: 508-435-6903
  • Fax: 508-435-2311
Mailing address:
  • Phone: 508-435-6903
  • Fax: 508-435-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0044953
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: