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General NPI Number Information
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NPI Number | 1023112604
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Entity Type | Individual
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Provider Name | PAUL JOSEPH PANTANO II DPM
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Gender | Male
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 32 SOUTH ST SUITE 300A
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City | WALTHAM
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State | MA
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Zip | 02453
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Country | US
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Telephone | 781-893-1443
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Fax | 781-231-9320
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Provider Business Mailing Address
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Address Line | PO BOX 540326
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City | WALTHAM
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State | MA
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Zip | 02454
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Country | US
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Telephone | 781-893-1443
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Fax | 781-231-9320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1547
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License Number State | MA
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