Provider Demographics
NPI:1639125289
Name:MATIA, PAMELA LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LEWIS
Last Name:MATIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 TWIN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3553
Mailing Address - Country:US
Mailing Address - Phone:410-737-5450
Mailing Address - Fax:410-737-5451
Practice Address - Street 1:1701 TWIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-3553
Practice Address - Country:US
Practice Address - Phone:410-737-5450
Practice Address - Fax:410-737-5451
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053734207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD651103100Medicaid
5581472WMedicare ID - Type Unspecified