Basic Information
Provider Information
NPI: 1235691650
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VIEIRA
FirstName: PAMELA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5100 COCONUT CREEK PKWY
Address2:  
City: MARGATE
State: FL
PostalCode: 330633913
CountryCode: US
TelephoneNumber: 9542817700
FaxNumber: 9547157603
Practice Location
Address1: 5100 COCONUT CREEK PKWY
Address2:  
City: MARGATE
State: FL
PostalCode: 330633913
CountryCode: US
TelephoneNumber: 9542817700
FaxNumber: 9547157603
Other Information
ProviderEnumerationDate: 04/03/2019
LastUpdateDate: 04/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XOS17893FLY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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