Provider Demographics
NPI:1114986171
Name:KOWALCZYK, PAMELA D H (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D H
Last Name:KOWALCZYK
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 1:15 MALS WAY
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085
Mailing Address - Country:US
Mailing Address - Phone:860-675-1318
Mailing Address - Fax:
Practice Address - Street 1:114 WOODLAND STREET
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-714-4280
Practice Address - Fax:860-714-8021
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT026168207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E48416Medicare UPIN