Provider Demographics
NPI:1245290774
Name:GREENSPON, PAMELA LYNNE (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNNE
Last Name:GREENSPON
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 1:10105 BANBURRY CROSS DRIVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6649
Mailing Address - Country:US
Mailing Address - Phone:702-260-4525
Mailing Address - Fax:702-869-0133
Practice Address - Street 1:10105 BANBURRY CROSS DRIVE
Practice Address - Street 2:SUITE 370
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6649
Practice Address - Country:US
Practice Address - Phone:702-260-4525
Practice Address - Fax:702-869-0133
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10952208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503751Medicaid