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General NPI Number Information
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NPI Number | 1811103609
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Entity Type | Individual
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Provider Name | TERESA JANE PAGANO M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7432 COUNTY HOUSE RD
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City | AUBURN
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State | NY
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Zip | 13021-8216
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Country | US
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Telephone | 315-258-2174
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Fax | 315-258-2105
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Provider Business Mailing Address
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Address Line | 2870 W LAKE RD
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City | CAZENOVIA
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State | NY
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Zip | 13035-9820
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Country | US
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Telephone | 315-655-2606
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Fax |
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 126926
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License Number State | NY
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