Provider Demographics
NPI:1609427095
Name:PAGAN, MAYRA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10920 SASSAN LN
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4069
Mailing Address - Country:US
Mailing Address - Phone:240-235-5253
Mailing Address - Fax:240-235-5253
Practice Address - Street 1:10920 SASSAN LN
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-4069
Practice Address - Country:US
Practice Address - Phone:240-217-3129
Practice Address - Fax:240-235-5253
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider