Provider Demographics
NPI:1568414548
Name:DE SILVA, PAMELA DEWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DEWAR
Last Name:DE SILVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4037
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-4037
Mailing Address - Country:US
Mailing Address - Phone:661-726-6255
Mailing Address - Fax:661-726-6261
Practice Address - Street 1:623 W AVENUE Q
Practice Address - Street 2:SUITE A
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3890
Practice Address - Country:US
Practice Address - Phone:661-726-6255
Practice Address - Fax:855-451-0552
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A488940Medicaid
CA00A488940Medicaid
CAE89785Medicare UPIN