Provider Demographics
NPI:1558171058
Name:SMALL, PAMELA M
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TWO PENNY LN
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1447
Mailing Address - Country:US
Mailing Address - Phone:978-807-8850
Mailing Address - Fax:
Practice Address - Street 1:33 TWO PENNY LN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1447
Practice Address - Country:US
Practice Address - Phone:978-807-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program