Healthcare Provider Details

I. General information

NPI: 1457228736
Provider Name (Legal Business Name): PAMELA CUSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2166 N COLE ST
LIMA OH
45801-2429
US

IV. Provider business mailing address

2166 N COLE ST
LIMA OH
45801-2429
US

V. Phone/Fax

Practice location:
  • Phone: 567-825-1194
  • Fax: 527-289-4172
Mailing address:
  • Phone: 567-825-1194
  • Fax: 527-289-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number25R-CPT3277
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: