Provider Demographics
NPI:1104862903
Name:NOURSE, PAMELA JW (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JW
Last Name:NOURSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:891 W MAIN ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1059
Mailing Address - Country:US
Mailing Address - Phone:207-564-4466
Mailing Address - Fax:207-564-4468
Practice Address - Street 1:891 W MAIN ST
Practice Address - Street 2:SUITE 700
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1059
Practice Address - Country:US
Practice Address - Phone:207-564-4466
Practice Address - Fax:207-564-4468
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME14885208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEHX3032OtherMEDICARE PTAN
MEP00061427OtherRAILROAD MEDICARE
G79008Medicare UPIN