Provider Demographics
NPI:1205860681
Name:HEATH, PAMELA JOCELYN ADRIENNE (DO)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JOCELYN ADRIENNE
Last Name:HEATH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10758
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5013
Mailing Address - Country:US
Mailing Address - Phone:434-710-4305
Mailing Address - Fax:434-202-5462
Practice Address - Street 1:4500 RIVERSIDE DR
Practice Address - Street 2:SUITE B
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5167
Practice Address - Country:US
Practice Address - Phone:434-710-4305
Practice Address - Fax:434-202-5462
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102201385207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407685100Medicaid
VAI 17176Medicare UPIN
MD407685100Medicaid