MEDICARE: MR. RONALD J PANTANO MD

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	207R00000X	Internal Medicine Physician	45076	MA

General Provider Information

NPI Number	:	1619979804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD J PANTANO MD

Provider Business Mailing Address
First Line	:	100 CENTRAL STREET
Second Line	:	4TH FLOOR
City	:	WORCESTER
State	:	MA
Zip	:	01608
Country	:	US
Telephone Number	:	508-363-3616
Fax Number	:	508-363-0607

Provider Business Practice Location Address
First Line	:	100 CENTRAL STREET
Second Line	:	4TH FLOOR
City	:	WORCESTER
State	:	MA
Zip	:	01608
Country	:	US
Telephone Number	:	508-363-3616
Fax Number	:	508-363-0607

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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