Healthcare Provider Details

I. General information

NPI: 1578559670
Provider Name (Legal Business Name): JESSICA BARBARA PAGANA-DEFAZIO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA BARBARA PAGANA

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 MARKET ST
SUNBURY PA
17801-2458
US

IV. Provider business mailing address

7 DOCK HILL RD
MIDDLEBURG PA
17842-8910
US

V. Phone/Fax

Practice location:
  • Phone: 570-286-8521
  • Fax: 570-286-6197
Mailing address:
  • Phone: 570-837-2123
  • Fax: 570-837-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012175
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: