Healthcare Provider Details

I. General information

NPI: 1215120571
Provider Name (Legal Business Name): PAMELA L NOTTINGHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST 602
MIAMI FL
33136-2137
US

IV. Provider business mailing address

1150 NW 14TH ST 602
MIAMI FL
33136-2137
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-7688
  • Fax: 305-243-8470
Mailing address:
  • Phone: 305-243-7688
  • Fax: 305-243-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS9672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: