Healthcare Provider Details

I. General information

NPI: 1861403693
Provider Name (Legal Business Name): JOHN J PAGONIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 REYNOLDS ROAD
BROOKS ME
04915
US

IV. Provider business mailing address

55 REYNOLDS RD SUITE 350
BROOKS ME
04921-3637
US

V. Phone/Fax

Practice location:
  • Phone: 207-722-3488
  • Fax: 207-722-3183
Mailing address:
  • Phone: 207-722-3488
  • Fax: 207-722-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01065594A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number018235
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: