Provider Demographics
NPI:1922314467
Name:CONLEY, PAMELA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MARIE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 RIDGELAKE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3829
Mailing Address - Country:US
Mailing Address - Phone:504-485-9551
Mailing Address - Fax:504-837-7988
Practice Address - Street 1:3350 RIDGELAKE DR STE 109
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3829
Practice Address - Country:US
Practice Address - Phone:504-485-9551
Practice Address - Fax:504-837-7988
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020568208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice