Provider Demographics
NPI:1346487204
Name:TAFFERA-DEIHL, PAMELA QUINN (DO)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:QUINN
Last Name:TAFFERA-DEIHL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1724
Mailing Address - Country:US
Mailing Address - Phone:717-721-4740
Mailing Address - Fax:717-738-6872
Practice Address - Street 1:169 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1724
Practice Address - Country:US
Practice Address - Phone:717-721-4740
Practice Address - Fax:717-738-6872
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012060207Q00000X
PAOS014828208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102504537Medicaid