Provider Demographics
NPI:1629106638
Name:CHANEY, PAMELA M (PT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:M
Last Name:CHANEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26045 SOTTERLEY HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-2659
Mailing Address - Country:US
Mailing Address - Phone:301-373-5827
Mailing Address - Fax:301-373-5753
Practice Address - Street 1:26045 SOTTERLEY HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-2659
Practice Address - Country:US
Practice Address - Phone:301-373-5827
Practice Address - Fax:301-373-5753
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14254174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD262834506OtherUNITED HEALTHCARE
MDF7CKPMOtherMD BCBS RENDERING PROV NO
MD144037 ZCM7OtherMEDICARE ID
MDN419OtherBC BS FEP
MD601566700OtherACS U.S. DEPT OF LABOR
MD53476701OtherBCBS PROFESSIONAL NUMBER
MD262834506OtherTRICARE
MD987000800Medicaid
MDN4190001OtherCAREFIRST BCBS BLUECHOICE & GHMSI
MDF7CKPMOtherMD BCBS RENDERING PROV NO