Provider Demographics
NPI:1669427308
Name:GROVER, PAMELA C (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:C
Last Name:GROVER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:421 PENBROOKE DR
Mailing Address - Street 2:SUITE #6
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2045
Mailing Address - Country:US
Mailing Address - Phone:585-623-4430
Mailing Address - Fax:585-623-4436
Practice Address - Street 1:421 PENBROOKE DR
Practice Address - Street 2:SUITE #6
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2045
Practice Address - Country:US
Practice Address - Phone:585-623-4430
Practice Address - Fax:585-623-4436
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2015-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME81917207Q00000X
FL271328-12083P0500X
NY2713282083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261611400Medicaid
FL080171075OtherRAILROAD MEDICARE PROVIDER NUMBER
H36046Medicare UPIN
FL261611400Medicaid