Basic Information
Provider Information
NPI: 1972950061
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HU
FirstName: PAMELA
MiddleName: P
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 789 HOWARD AVE
Address2: YNHH PEDIATRICS
City: NEW HAVEN
State: CT
PostalCode: 065191304
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 789 HOWARD AVE
Address2: YNHH PEDIATRICS
City: NEW HAVEN
State: CT
PostalCode: 065191304
CountryCode: US
TelephoneNumber: 2036885555
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/18/2016
LastUpdateDate: 01/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X64189CTY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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