Provider Demographics
NPI:1255534921
Name:CORSON, PAMELA (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CORSON
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 1:3495 LAKESIDE DR
Mailing Address - Street 2:205
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4841
Mailing Address - Country:US
Mailing Address - Phone:775-829-7999
Mailing Address - Fax:
Practice Address - Street 1:971 W MOANA LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4844
Practice Address - Country:US
Practice Address - Phone:775-829-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9194332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site