Provider Demographics
NPI:1679548663
Name:PAGANO, ANN MARIE (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:PAGANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1140 BURNT TAVERN RD
Mailing Address - Street 2:STE 2A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1496
Mailing Address - Country:US
Mailing Address - Phone:732-202-0700
Mailing Address - Fax:732-202-0664
Practice Address - Street 1:1140 BURNT TAVERN RD
Practice Address - Street 2:STE 2A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1496
Practice Address - Country:US
Practice Address - Phone:732-202-0700
Practice Address - Fax:732-202-0664
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA071298207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8452407Medicaid
H31479Medicare UPIN
NJ8452407Medicaid