Provider Demographics
NPI:1134105604
Name:PARKER, PAMELA GILSTAD (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:GILSTAD
Last Name:PARKER
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 1:12301 OLD COLUMBIA PIKE
Mailing Address - Street 2:#300
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1656
Mailing Address - Country:US
Mailing Address - Phone:301-625-2800
Mailing Address - Fax:301-625-9046
Practice Address - Street 1:12301 OLD COLUMBIA PIKE
Practice Address - Street 2:#300
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1656
Practice Address - Country:US
Practice Address - Phone:301-625-2800
Practice Address - Fax:301-625-9046
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30739208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD36804100Medicaid