Provider Demographics
NPI:1346437340
Name:UDOMPRASERT, PAMELA S (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:UDOMPRASERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 ROCHESTER HILL RD STE 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1709
Practice Address - Country:US
Practice Address - Phone:603-332-0238
Practice Address - Fax:603-332-7098
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045967208000000X
VT042-0012099208000000X
NH16930208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics