Healthcare Provider Details

I. General information

NPI: 1669470969
Provider Name (Legal Business Name): PAMELA JOYCE WANSKER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA JOYCE WANSKER II DO

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 ROUTE 202 BOX 539
GREENE ME
04236-4208
US

IV. Provider business mailing address

85 LAKESIDE DR
FALMOUTH ME
04105-2486
US

V. Phone/Fax

Practice location:
  • Phone: 207-946-5444
  • Fax: 207-946-2544
Mailing address:
  • Phone: 207-878-3479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1037
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: