Provider Demographics
NPI:1639208846
Name:FADNESS, PAMELA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:KAY
Last Name:FADNESS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-1266
Mailing Address - Fax:802-479-3548
Practice Address - Street 1:713 E MARION AVE STE 139
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3863
Practice Address - Country:US
Practice Address - Phone:941-833-1750
Practice Address - Fax:941-766-1511
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-00113672084P0800X
FLME1349222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013985Medicaid