Provider Demographics
NPI:1700883527
Name:CHENEY, PAMELA HILLYARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:HILLYARD
Last Name:CHENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:CHENEY
Other - Last Name:GASTWIRT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:416 WESTON RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482
Mailing Address - Country:US
Mailing Address - Phone:781-489-5146
Mailing Address - Fax:339-686-3003
Practice Address - Street 1:416 WESTON RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482
Practice Address - Country:US
Practice Address - Phone:781-489-5146
Practice Address - Fax:339-686-3003
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158969208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0023535OtherNEIGHBORHOOD HEALTH
158969OtherTUFTS BENEFIT ADMINISTRAT
802390OtherHARVARD PILGRIM
802390OtherHARVARD PILGRIM POS
158969OtherTUFTS TOTAL HEALTH PLAN
802390OtherFIRST SENIORITY
J21147OtherBS-BLUE CARE ELECT
J21147OtherBLUE SHIELD INDEMNITYY
J21147OtherHMO BLUE/BLUE CHOICE
158969OtherTUFTS
3191117OtherMASS HEALTH
MA8167125OtherHEALTHSOURCE
020053191OtherRAILROAD MEDICARE
802390OtherHARVARD PILGRIM PPO
158969OtherTUFTS COMMONWEALTH PPO
158969OtherTUFTS SECURE HORIZONS
40043OtherCHILDREN'S MED SECURITY
8167125OtherCIGNA HEALTH CARE
158969OtherTUFTS COMMONWEALTH PPO
J21147OtherBS-BLUE CARE ELECT