Provider Demographics
NPI:1043204431
Name:PAMELA PAPOLA MD PA
Entity Type:Organization
Organization Name:PAMELA PAPOLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:941-255-3722
Mailing Address - Street 1:PO BOX 511896
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-1896
Mailing Address - Country:US
Mailing Address - Phone:941-255-3722
Mailing Address - Fax:941-255-3723
Practice Address - Street 1:3410 TAMIAMI TRL
Practice Address - Street 2:1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8127
Practice Address - Country:US
Practice Address - Phone:941-255-3722
Practice Address - Fax:941-255-3723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71336OtherBCBS
FLF71354Medicare UPIN
FL71336OtherBCBS