Provider Demographics
NPI:1295775286
Name:WERNER, PAMELA S (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:WERNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B3
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:51 E STEWART ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2624
Practice Address - Country:US
Practice Address - Phone:937-208-9010
Practice Address - Fax:937-208-9010
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35048927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0813525Medicaid
OH0635265Medicare PIN
E96447Medicare UPIN
OH0635264Medicare PIN