Provider Demographics
NPI:1750421962
Name:LONDON, PAMELA (DO)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FRIENDS HOSPITAL
Mailing Address - Street 2:4641 ROOSEVELT BOULEVARD
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2399
Mailing Address - Country:US
Mailing Address - Phone:215-831-4600
Mailing Address - Fax:215-831-4700
Practice Address - Street 1:4641 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2343
Practice Address - Country:US
Practice Address - Phone:215-831-4600
Practice Address - Fax:215-831-4700
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006881L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF59760 UPINMedicare UPIN
PA743878Medicare PIN