Provider Demographics
NPI:1417956376
Name:CHAWLA, PAMELA G (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:CHAWLA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2910 CENTRE POINT DR, 35-121A
Mailing Address - Street 2:CHILDREN'S HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1182
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 SMITH AVE N
Practice Address - Street 2:CHILDREN'S PRIMARY CLINIC - STPL
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2387
Practice Address - Country:US
Practice Address - Phone:651-220-6789
Practice Address - Fax:651-220-6807
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-10-25
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Provider Licenses
StateLicense IDTaxonomies
MN41278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN766725600Medicaid
MN766725600Medicaid
H74733Medicare UPIN