Provider Demographics
NPI:1528066032
Name:DEMNICKI, PAMELA T (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:T
Last Name:DEMNICKI
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 1:915 OLD FERN HILL RD
Mailing Address - Street 2:BUILDING B, SUITE 201
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4269
Mailing Address - Country:US
Mailing Address - Phone:610-436-6696
Mailing Address - Fax:610-430-6023
Practice Address - Street 1:915 OLD FERN HILL ROAD
Practice Address - Street 2:BUILDING B, SUITE 201
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3431
Practice Address - Country:US
Practice Address - Phone:610-436-6696
Practice Address - Fax:610-430-6023
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC10005645208600000X
PAMD060771L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000942301Medicaid
DE0000942301Medicaid
G95247Medicare UPIN