Provider Demographics
NPI:1538477294
Name:PAMELA E. JACKSON, MD LLC
Entity Type:Organization
Organization Name:PAMELA E. JACKSON, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-939-1541
Mailing Address - Street 1:9 MOTT AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3330
Mailing Address - Country:US
Mailing Address - Phone:203-939-1541
Mailing Address - Fax:203-939-1545
Practice Address - Street 1:9 MOTT AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3330
Practice Address - Country:US
Practice Address - Phone:203-939-1541
Practice Address - Fax:203-939-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty