Provider Demographics
NPI:1467534164
Name:REDDEN, PAMELA L (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:L
Last Name:REDDEN
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 1:12100 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1444
Mailing Address - Country:US
Mailing Address - Phone:216-851-2600
Mailing Address - Fax:
Practice Address - Street 1:12100 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1444
Practice Address - Country:US
Practice Address - Phone:216-851-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0496958Medicaid
OH2022981Medicare PIN
OHA80507Medicare UPIN