Provider Demographics
NPI:1669454542
Name:LEVINE, PAMELA L (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:L
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:HORSTMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:NORTH MEDICAL OFFICE BUILDING
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-203-7180
Mailing Address - Fax:970-203-7105
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:NORTH MEDICAL OFFICE BUILDING
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-203-7180
Practice Address - Fax:970-203-7105
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00944660OtherMEDICARE RAILROAD CARRIER PTAN
CO01367036Medicaid
COE35214Medicare UPIN
CO01367036Medicaid
COCOA102138Medicare PIN