Basic Information
| Provider Information | |||||||||
| NPI: | 1255413266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O CONNOR | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RPA C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CLEVELAND MEYERS | ||||||||
| OtherFirstName: | PAMELA | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 220 LINDEN OAKS SUITE 200 | ||||||||
| Address2: | PANORAMA PEDIATRIC GROUP RLLP | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853814982 | ||||||||
| FaxNumber: | 5853811821 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 LINDEN OAKS SUITE 200 | ||||||||
| Address2: | PANORAMA PEDIATRIC GROUP RLLP | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853814982 | ||||||||
| FaxNumber: | 5853811821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0069001 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.