Provider Demographics
NPI:1245303627
Name:WINE, PAMELA R (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:R
Last Name:WINE
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Gender:
Credentials:MD
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Mailing Address - Street 1:406 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6700
Mailing Address - Country:US
Mailing Address - Phone:781-209-5847
Mailing Address - Fax:781-209-5847
Practice Address - Street 1:406 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6700
Practice Address - Country:US
Practice Address - Phone:781-209-5847
Practice Address - Fax:781-209-5847
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2025-03-31
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Provider Licenses
StateLicense IDTaxonomies
MA1514402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry