Healthcare Provider Details

I. General information

NPI: 1366481996
Provider Name (Legal Business Name): PAMELA M BARTHOLOMEW M D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67241 INDUSTRY LN
COVINGTON LA
70433-8705
US

IV. Provider business mailing address

PO BOX 1750
COVINGTON LA
70434-1750
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-7206
  • Fax: 985-892-9990
Mailing address:
  • Phone: 985-892-7206
  • Fax: 985-892-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number019986
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: