Provider Demographics
NPI:1750389524
Name:MANTHOUS, PAMELA L (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:L
Last Name:MANTHOUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:BALLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:GROVE HILL MEDICAL CENTER
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3916
Mailing Address - Country:US
Mailing Address - Phone:860-666-5111
Mailing Address - Fax:860-666-5153
Practice Address - Street 1:18 CEDAR ST
Practice Address - Street 2:GROVE HILL MEDICAL CENTER
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2647
Practice Address - Country:US
Practice Address - Phone:860-666-5111
Practice Address - Fax:860-666-5153
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032643207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3264301OtherCONNECTICARE PROV ID
CT368783OtherWELLCARE MEDICARE
CT912607OtherHEALTH NET REF ID
CT010032643CTOtherBCBS N BCFP PROV ID
CT01032643OtherCIGNA PROV ID
CT060074OtherHEALTH NET PROV ID
CT004196095Medicaid
CT1255448155OtherGHMC GRP NPI PROV ID
CT500222OtherAETNA PROV ID
CTP369849OtherOXFORD PROV ID
CT001326439Medicaid
CTP369849OtherOXFORD PROV ID
CT500222OtherAETNA PROV ID
CT060074OtherHEALTH NET PROV ID