Provider Demographics
NPI:1063456929
Name:OLIVER, PAMELA ALSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ALSTON
Last Name:OLIVER
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-765-5470
Mailing Address - Fax:336-765-5428
Practice Address - Street 1:114 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1522
Practice Address - Country:US
Practice Address - Phone:336-765-5470
Practice Address - Fax:336-499-5428
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500705207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901567Medicaid
NC2044460Medicare ID - Type Unspecified
NC5901567Medicaid
NC2044460AMedicare PIN