Provider Demographics
NPI:1720159106
Name:DEFOREST, PAMELA M (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:DEFOREST
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 1:3673 MARCY ST
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1055
Mailing Address - Country:US
Mailing Address - Phone:718-920-5157
Mailing Address - Fax:
Practice Address - Street 1:CENTENNIAL WOMEN'S CENTER
Practice Address - Street 2:3332 ROCHAMBEAU AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195044207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology