Provider Demographics
NPI:1811953565
Name:WRATCHFORD, PAMELA CASE (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:CASE
Last Name:WRATCHFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7493 RIGHT FLANK RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116
Mailing Address - Country:US
Mailing Address - Phone:804-559-2916
Mailing Address - Fax:804-559-9206
Practice Address - Street 1:7493 RIGHT FLANK RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-559-2916
Practice Address - Fax:804-559-9206
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101234730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010013534Medicaid
54-2112114OtherTAX ID
54-2112114OtherTAX ID
VAH60887Medicare UPIN
H60887Medicare UPIN