Provider Demographics
NPI:1083693287
Name:SANTAMARIA, PAMELA (MD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:SANTAMARIA
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 1:4242 FARNAM ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2806
Mailing Address - Country:US
Mailing Address - Phone:402-552-2650
Mailing Address - Fax:402-552-2655
Practice Address - Street 1:4242 FARNAM ST
Practice Address - Street 2:SUITE 500
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2806
Practice Address - Country:US
Practice Address - Phone:402-552-2650
Practice Address - Fax:402-552-2655
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22135207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2551036Medicaid
NE10025242300Medicaid
91739OtherWELLMARK
NEH57912Medicare UPIN
NE10025242300Medicaid