Provider Demographics
NPI:1033193057
Name:WARD, PAMELA J (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:WARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 WOODBURY AVENUE, SUITE 103
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03805
Mailing Address - Country:US
Mailing Address - Phone:603-431-6691
Mailing Address - Fax:603-431-6794
Practice Address - Street 1:2064 WOODBURY AVENUE, SUITE 103
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03805
Practice Address - Country:US
Practice Address - Phone:603-431-6691
Practice Address - Fax:603-431-6794
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0542P363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431769299Medicaid
NH30333512Medicaid
AP2403Medicare ID - Type Unspecified