Provider Demographics
NPI:1497785422
Name:RUESCHER, PAMELA FLOYD
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:FLOYD
Last Name:RUESCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3238
Mailing Address - Country:US
Mailing Address - Phone:757-399-7300
Mailing Address - Fax:
Practice Address - Street 1:3500 QUEEN ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3238
Practice Address - Country:US
Practice Address - Phone:757-399-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04771OtherMEDICARE GROUP