Provider Demographics
NPI:1326034794
Name:WHITING EVANS, PAMELA S (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:WHITING EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:WHITING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:816 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 2H
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-363-6610
Mailing Address - Fax:757-363-6611
Practice Address - Street 1:816 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 2H
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-363-6610
Practice Address - Fax:757-363-6611
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-05-15
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
VA01010544932084N0400X
NC99008272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912159Medicaid
NC12159OtherBLUE CROSS BLUE SHIELD NC
NC12159OtherBLUE CROSS BLUE SHIELD NC
NC8912159Medicaid