Provider Demographics
NPI:1902859283
Name:WARREN, PAM (MD)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAM
Other - Middle Name:
Other - Last Name:HOLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1702 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3315
Mailing Address - Country:US
Mailing Address - Phone:530-898-0504
Mailing Address - Fax:530-898-9647
Practice Address - Street 1:1702 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3315
Practice Address - Country:US
Practice Address - Phone:530-898-0504
Practice Address - Fax:530-898-9647
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010466192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA300001023Medicare PIN
VA300002488Medicare PIN
300021393Medicare PIN
300129303Medicare PIN
E36511Medicare UPIN
VA300002489Medicare PIN