Healthcare Provider Details

I. General information

NPI: 1255499984
Provider Name (Legal Business Name): GARY THOMAS PAGANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

IV. Provider business mailing address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-3568
  • Fax: 440-285-4552
Mailing address:
  • Phone: 440-285-3568
  • Fax: 440-285-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-04-2281-P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: