Provider Demographics
NPI:1609873009
Name:SMITH, PAMELA G (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:G
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:291 MCBRIDE LN
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-2773
Mailing Address - Country:US
Mailing Address - Phone:434-656-1274
Mailing Address - Fax:
Practice Address - Street 1:291 MCBRIDE LN
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-2773
Practice Address - Country:US
Practice Address - Phone:434-656-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047209207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
45419OtherSENTARA/OPTIMA PROVIDER N
VA010215064Medicaid
NC1609873009Medicaid
203639329OtherPCHP PROVIDER NUMBER
48580OtherMEDCOST PROVIDER NUMBER
010215064OtherVA PREMIER PROVIDER NUMBE
700010638OtherCIGNA PROVIDER NUMBER
329073OtherSOUTHERN HEALTH PROVIDER
NC5916492Medicaid
203639329013OtherTRICARE PROVIDER NUMBER
SCQ01837Medicaid
186413OtherANTHEM PROVIDER NUMBER
203639329OtherUNITED HEALTHCARE
186413OtherANTHEM PROVIDER NUMBER
NCNCL976CMedicare PIN
203639329OtherUNITED HEALTHCARE
329073OtherSOUTHERN HEALTH PROVIDER
009500C04Medicare PIN
203639329OtherPCHP PROVIDER NUMBER
NC5916492Medicaid
P00283942Medicare PIN