Healthcare Provider Details

I. General information

NPI: 1659362788
Provider Name (Legal Business Name): PAMELA WHITNEY SCHAEFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST GRB 2 RADIOLOGICAL ASSOCIATES
BOSTON MA
02114-2696
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8787
  • Fax:
Mailing address:
  • Phone: 617-726-8787
  • Fax: 617-724-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number78379
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number78379
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: