MEDICARE: DR. PAMELA M. F. MANOLSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZD0900X	Dermatopathology (Pathology) Physician	ME 84171	FL
2	207ZD0900X	Dermatopathology (Pathology) Physician	A79245	CA
3	207ZP0101X	Anatomic Pathology Physician	ME84171	FL

General Provider Information

NPI Number	:	1912120536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA M. F. MANOLSON M.D.

Provider Business Mailing Address
First Line	:	20001 LOMOND LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3347
Country	:	US
Telephone Number	:	813-486-3082
Fax Number	:

Provider Business Practice Location Address
First Line	:	20001 LOMOND LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3347
Country	:	US
Telephone Number	:	813-486-3082
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/11/2016

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