Healthcare Provider Details

I. General information

NPI: 1689991283
Provider Name (Legal Business Name): GINA ANNE PAGOTTO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 OLD LANCASTER RD STE 440
BRYN MAWR PA
19010-3236
US

IV. Provider business mailing address

825 OLD LANCASTER RD STE 320
BRYN MAWR PA
19010-3235
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-4511
  • Fax: 610-525-8561
Mailing address:
  • Phone: 610-527-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberVP005718C
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN324853L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: