Provider Demographics
NPI:1134122666
Name:HENDERSON, PAMELA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:RENEE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:299 CAREW ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2361
Mailing Address - Country:US
Mailing Address - Phone:413-733-1818
Mailing Address - Fax:413-732-2341
Practice Address - Street 1:299 CAREW ST
Practice Address - Street 2:STE 400
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2361
Practice Address - Country:US
Practice Address - Phone:413-733-1818
Practice Address - Fax:413-732-2341
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2012-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA215993207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0178501Medicaid
F66249Medicare UPIN
MAA34892Medicare ID - Type Unspecified