MEDICARE: DR. MARC ROBERT PAGANO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3320	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	160013	OTHER	OH	VALUE OPTIONS
3	341485124	OTHER	OH	MEDICAL MUTUAL OF OHIO

General Provider Information

NPI Number	:	1457560054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC ROBERT PAGANO PH.D.

Provider Business Mailing Address
First Line	:	11528 ROYALTON RD
Second Line	:	SUITE 101
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-4469
Country	:	US
Telephone Number	:	440-582-3310
Fax Number	:	440-582-3310

Provider Business Practice Location Address
First Line	:	11528 ROYALTON RD
Second Line	:	SUITE 101
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-4469
Country	:	US
Telephone Number	:	440-582-3310
Fax Number	:	440-582-3310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	04/12/2011

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