Provider Demographics
NPI:1700846326
Name:BURDETT, PAMELA HAY (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:HAY
Last Name:BURDETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:HAY
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 N PETERS RD
Mailing Address - Street 2:STE 225
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:865-694-7907
Practice Address - Street 1:8 CADILLAC DRIVE
Practice Address - Street 2:STE 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-376-7500
Practice Address - Fax:615-376-7575
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN381852085R0202X
NMTM2003-07552085R0202X
GA0656692085R0202X
MT105712085R0202X
OH825582085R0202X
FLME946142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3892983Medicaid
G66171Medicare UPIN
TN3892983Medicaid