Provider Demographics
NPI:1992785109
Name:HERRINGTON, PAMELA JEAN (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:HERRINGTON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-6979
Mailing Address - Country:US
Mailing Address - Phone:570-873-3440
Mailing Address - Fax:570-873-3572
Practice Address - Street 1:345 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-6979
Practice Address - Country:US
Practice Address - Phone:570-873-3440
Practice Address - Fax:570-873-3572
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044863L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012800520006Medicaid
PA0012800520006Medicaid
PA019821OtherHIGHMARK BLUE SHIELD
PA7994-C241OtherGEISINGER
PA232175463OtherAMERIHEALTH
PA019821D6YMedicare PIN
PA080161286OtherPALMETTO/MC RAILROAD
PA002484OtherFIRST PRIORITY HEALTH
PAF24272Medicare UPIN