Provider Demographics
NPI:1578678850
Name:HAMILTON-STUBBS, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HAMILTON-STUBBS
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:PO BOX 6044
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-0044
Mailing Address - Country:US
Mailing Address - Phone:804-273-9900
Mailing Address - Fax:
Practice Address - Street 1:208 E BROOKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2723
Practice Address - Country:US
Practice Address - Phone:804-273-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA130020570OtherMEDICARE RAILROAD
VA242985OtherAETNA HMO
VA4900038OtherUNITED HEALTHCARE
VA541856110OtherMAILHANDLERS
VA113137OtherANTHEM
VA6105149Medicaid
VA7878169OtherAETNA PPO
VAMF185OtherKEYADVANTAGE
VA541856110OtherTRICARE STANDARD
VA541856110OtherCIGNA
VA6405149OtherVA PREMIER
VA453589OtherANTHEM
VA462765OtherANTHEM
VA541856110OtherPREFERRED ADMINISTRATOR
VA453589OtherANTHEM
VA462765OtherANTHEM