=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952744054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THADDEUS MATTHEW PAJAK DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2013
-----------------------------------------------------
Last Update Date | 08/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 CAMEO LN
-----------------------------------------------------
City | GREENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-238-6668
-----------------------------------------------------
Fax | 724-238-6080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 JEFFERSON AVE STE 400
-----------------------------------------------------
City | JEANNETTE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15644-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-689-1822
-----------------------------------------------------
Fax | 724-522-4002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS019106
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------