Provider Demographics
NPI:1205867645
Name:GWATHMEY, PAMELA LESTER (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LESTER
Last Name:GWATHMEY
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:804-769-0508
Practice Address - Street 1:142 SMITHFIELD ROAD
Practice Address - Street 2:
Practice Address - City:SAINT STEPHENS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:23148-0041
Practice Address - Country:US
Practice Address - Phone:804-769-0103
Practice Address - Fax:804-769-0508
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101038630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005823714Medicaid
VA6967223OtherCIGNA
VA96465OtherSOUTHERN HEALTH
VA10000353OtherOPTIMA
VA396694OtherANTHEM
VA12465OtherCARENET
VA4136176OtherAETNA