Provider Demographics
NPI:1154487080
Name:BAGDASIAN, PAMELA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:BAGDASIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SCHOOL ST STE 109
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5335
Mailing Address - Country:US
Mailing Address - Phone:401-227-9940
Mailing Address - Fax:401-227-9939
Practice Address - Street 1:333 SCHOOL ST STE 109
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5335
Practice Address - Country:US
Practice Address - Phone:401-227-9940
Practice Address - Fax:401-227-9939
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P95548Medicare UPIN