Provider Demographics
NPI:1215998281
Name:AMELUNG, PAMELA JAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JAYNE
Last Name:AMELUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-705-5762
Mailing Address - Fax:410-705-7915
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-705-5762
Practice Address - Fax:410-705-7915
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39414207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5851858Medicaid
MD064521400Medicaid
MD52070603OtherBC/BS
DE1215998281Medicaid
MDE49940Medicare UPIN
MD064521400Medicaid
MD290009144Medicare PIN