Provider Demographics
NPI:1366481996
Name:BARTHOLOMEW, PAMELA M (M D)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-1750
Mailing Address - Country:US
Mailing Address - Phone:985-892-7206
Mailing Address - Fax:985-892-9990
Practice Address - Street 1:67241 INDUSTRY LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8705
Practice Address - Country:US
Practice Address - Phone:985-892-7206
Practice Address - Fax:985-892-9990
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019986207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1977667Medicaid
F58481Medicare UPIN
5R691Medicare ID - Type Unspecified