Provider Demographics
NPI:1699860411
Name:WISEMAN, PAMELA MARKIEWICZ (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MARKIEWICZ
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:MARKIEWICZ-WISEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5318 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3036
Mailing Address - Country:US
Mailing Address - Phone:504-452-8737
Mailing Address - Fax:504-207-3067
Practice Address - Street 1:3201 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-4307
Practice Address - Country:US
Practice Address - Phone:504-207-3060
Practice Address - Fax:504-207-3067
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11949R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00910599Medicaid
MS08004801Medicaid
LA1684660Medicaid
LA1684660Medicaid
AL00910599Medicaid