Provider Demographics
NPI:1992776181
Name:STRANGE, PAMELA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LEE
Last Name:STRANGE
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 1:7221 ENGLE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2233
Mailing Address - Country:US
Mailing Address - Phone:260-432-1568
Mailing Address - Fax:260-432-4969
Practice Address - Street 1:7221 ENGLE RD STE 220
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2233
Practice Address - Country:US
Practice Address - Phone:260-432-1568
Practice Address - Fax:260-432-4969
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010429062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100372890Medicaid
OH0983726Medicaid
MI1992776181Medicaid
MIMI1209010Medicare PIN
MIP00787721Medicare PIN
IN300039800Medicare PIN
MI1992776181Medicaid
IN981270PMedicare PIN
E68013Medicare UPIN