Provider Demographics
NPI:1942290317
Name:GAVIN, PAMELA J (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:GAVIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12931 OAK HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2914
Mailing Address - Country:US
Mailing Address - Phone:301-797-9600
Mailing Address - Fax:301-797-3854
Practice Address - Street 1:103 MARCLEY DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2977
Practice Address - Country:US
Practice Address - Phone:304-263-0964
Practice Address - Fax:304-267-3899
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV30521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily