Healthcare Provider Details

I. General information

NPI: 1952744054
Provider Name (Legal Business Name): THADDEUS MATTHEW PAJAK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CAMEO LN
GREENSBURG PA
15601
US

IV. Provider business mailing address

520 JEFFERSON AVE STE 400
JEANNETTE PA
15644-2538
US

V. Phone/Fax

Practice location:
  • Phone: 724-238-6668
  • Fax: 724-238-6080
Mailing address:
  • Phone: 724-689-1822
  • Fax: 724-522-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS019106
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: