Provider Demographics
NPI:1669470969
Name:WANSKER, PAMELA JOYCE (DO)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JOYCE
Last Name:WANSKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:JOYCE
Other - Last Name:WANSKER
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:85 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2486
Mailing Address - Country:US
Mailing Address - Phone:207-878-3479
Mailing Address - Fax:
Practice Address - Street 1:344 ROUTE 202
Practice Address - Street 2:BOX 539
Practice Address - City:GREENE
Practice Address - State:ME
Practice Address - Zip Code:04236-4208
Practice Address - Country:US
Practice Address - Phone:207-946-5444
Practice Address - Fax:207-946-2544
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME113760000Medicaid
ME015482Medicare PIN
MEE12723Medicare UPIN