1669470969 NPI number — DR. PAMELA JOYCE WANSKER DO

Table of content: ALEYDA TOBAR (NPI 1831083435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669470969 NPI number — DR. PAMELA JOYCE WANSKER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANSKER
Provider First Name:
PAMELA
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WANSKER
Provider Other First Name:
PAMELA
Provider Other Middle Name:
JOYCE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
II
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669470969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 LAKESIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04105-2486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-878-3479
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 ROUTE 202
Provider Second Line Business Practice Location Address:
BOX 539
Provider Business Practice Location Address City Name:
GREENE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04236-4208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-946-5444
Provider Business Practice Location Address Fax Number:
207-946-2544
Provider Enumeration Date:
07/11/2005

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: 207Q00000X , with the licence number:  1037 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 113760000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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