Provider Demographics
NPI:1881959039
Name:JOHN N. PANDISCIO, M.D. FAMILY MEDICINE
Entity type:Organization
Organization Name:JOHN N. PANDISCIO, M.D. FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:PANDISCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-435-6903
Mailing Address - Street 1:169 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2175
Mailing Address - Country:US
Mailing Address - Phone:508-435-6903
Mailing Address - Fax:508-435-2311
Practice Address - Street 1:169 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-2175
Practice Address - Country:US
Practice Address - Phone:508-435-6903
Practice Address - Fax:508-435-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6193358Medicaid
MAA57882Medicare UPIN