Healthcare Provider Details

I. General information

NPI: 1700883527
Provider Name (Legal Business Name): PAMELA HILLYARD CHENEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA CHENEY GASTWIRT M.D.

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 WESTON RD
WELLESLEY MA
02482
US

IV. Provider business mailing address

416 WESTON RD
WELLESLEY MA
02482
US

V. Phone/Fax

Practice location:
  • Phone: 781-489-5146
  • Fax: 339-686-3003
Mailing address:
  • Phone: 781-489-5146
  • Fax: 339-686-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number158969
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: