1336133917 NPI number — MS. PAMELA M ZISSELMAN C.R.N.P.

Table of content: MS. PAMELA M ZISSELMAN C.R.N.P. (NPI 1336133917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336133917 NPI number — MS. PAMELA M ZISSELMAN C.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZISSELMAN
Provider First Name:
PAMELA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336133917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6334 CEDAR LN
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-3898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-531-2355
Provider Business Mailing Address Fax Number:
410-531-7041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6334 CEDAR LN
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-3898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-531-2355
Provider Business Practice Location Address Fax Number:
410-531-7041
Provider Enumeration Date:
09/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  SP001583H , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: R222718 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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