Healthcare Provider Details

I. General information

NPI: 1396718243
Provider Name (Legal Business Name): PASQUALE MIGNANO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PENN BLVD SUITE 103
PHILA PA
19144-1416
US

IV. Provider business mailing address

2 PENN BLVD SUITE 103
PHILA PA
19144
US

V. Phone/Fax

Practice location:
  • Phone: 215-842-0406
  • Fax: 215-842-3215
Mailing address:
  • Phone: 215-842-0406
  • Fax: 215-842-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS009333-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: