Provider Demographics
NPI:1639152218
Name:CAVANAUGH, PAMELA BLANKS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:BLANKS
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 VANDERBILT PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1700
Mailing Address - Country:US
Mailing Address - Phone:828-258-0397
Mailing Address - Fax:828-258-3390
Practice Address - Street 1:4 VANDERBILT PARK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1700
Practice Address - Country:US
Practice Address - Phone:828-258-0397
Practice Address - Fax:828-258-3390
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9500783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8921771Medicaid
NC21771OtherBCBS
NCF65237Medicare UPIN
NC8921771Medicaid