Provider Demographics
NPI:1295853141
Name:HALE, PAMELA CANDACE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:CANDACE
Last Name:HALE
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 1:215 DAYTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1703
Mailing Address - Country:US
Mailing Address - Phone:937-689-6096
Mailing Address - Fax:
Practice Address - Street 1:215 DAYTON ST APT 1
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1703
Practice Address - Country:US
Practice Address - Phone:937-689-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA061789208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E45847Medicare UPIN