Provider Demographics
NPI:1043284920
Name:HRUBY, PAMELA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEAN
Last Name:HRUBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 MCCRACKEN RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2964
Mailing Address - Country:US
Mailing Address - Phone:216-663-7355
Mailing Address - Fax:216-663-7193
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:SUITE 450
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-663-7355
Practice Address - Fax:216-663-7193
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079762H207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000564656OtherANTHEM BLUE SHIELD
OH2292611Medicaid
OH000000564033OtherANTHEM BLUE SHIELD
OHT79762OtherSUMMACARE
P00285728Medicare PIN
OH4068465Medicare PIN
4068467Medicare PIN
OHP00724755Medicare PIN
OH7420541Medicare PIN
OH4068464Medicare PIN
OH000000564656OtherANTHEM BLUE SHIELD