Provider Demographics
NPI:1366554883
Name:CORNELIUS, PAMELA BELTRAN (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:BELTRAN
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:895 MIDDLE GROUND BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4250
Mailing Address - Country:US
Mailing Address - Phone:757-873-0161
Mailing Address - Fax:757-873-0205
Practice Address - Street 1:895 MIDDLE GROUND BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4250
Practice Address - Country:US
Practice Address - Phone:757-873-0161
Practice Address - Fax:757-873-0205
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101226094207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5099115Medicaid
G77810Medicare UPIN