Provider Demographics
NPI:1881623718
Name:NEW, PAMELA (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:NEW
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 1:2248 COUNTY ROAD 387
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964-5725
Mailing Address - Country:US
Mailing Address - Phone:713-819-5268
Mailing Address - Fax:
Practice Address - Street 1:2248 COUNTY ROAD 387
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-5725
Practice Address - Country:US
Practice Address - Phone:713-819-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8634207T00000X, 2084N0400X
IN01081580A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX048562505Medicaid
TX8R9877OtherBLUE CROSS BLUE SHIELD
TX8S4533OtherBLUE CROSS BLUE SHIELD
TXP00442041OtherRAILROAD MEDICARE
TX048562504Medicaid
TX8AE978OtherBLUE CROSS BLUE SHIELD
TX048562504Medicaid
TXP00442041OtherRAILROAD MEDICARE
TX8S4533OtherBLUE CROSS BLUE SHIELD
TX8G3872Medicare PIN