Provider Demographics
NPI:1881994648
Name:BURNETT, PAMELA A (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:BURNETT
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-0129
Mailing Address - Country:US
Mailing Address - Phone:317-468-6260
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:300 E BOYD AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2834
Practice Address - Country:US
Practice Address - Phone:317-462-3441
Practice Address - Fax:317-462-5476
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036118A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine