Provider Demographics
NPI:1366541518
Name:NGUYEN, PAMELA H (DO)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:H
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E MAIN ST
Mailing Address - Street 2:RADIOLOGIC ASSOCIATES, PC
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:845-333-1258
Mailing Address - Fax:845-343-0617
Practice Address - Street 1:707 E MAIN ST
Practice Address - Street 2:RADIOLOGIC ASSOCIATES, PC
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2650
Practice Address - Country:US
Practice Address - Phone:845-333-1258
Practice Address - Fax:845-343-0617
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2607852085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113204OtherMEDICAL LICENSE
ILBLUE SHIELDOther021622158
NY03358752Medicaid
NYA400053299Medicare PIN