Provider Demographics
NPI:1326055336
Name:QUARANTILLO, PAMELA LARGENT (MD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LARGENT
Last Name:QUARANTILLO
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 1:81 WAR MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411
Mailing Address - Country:US
Mailing Address - Phone:304-258-8805
Mailing Address - Fax:304-258-8846
Practice Address - Street 1:81 WAR MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411
Practice Address - Country:US
Practice Address - Phone:304-258-8805
Practice Address - Fax:304-258-8846
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17621208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0108919000Medicaid
F69080Medicare UPIN