Healthcare Provider Details

I. General information

NPI: 1326055336
Provider Name (Legal Business Name): PAMELA LARGENT QUARANTILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 WAR MEMORIAL DR
BERKELEY SPRINGS WV
25411
US

IV. Provider business mailing address

81 WAR MEMORIAL DR
BERKELEY SPRINGS WV
25411
US

V. Phone/Fax

Practice location:
  • Phone: 304-258-8805
  • Fax: 304-258-8846
Mailing address:
  • Phone: 304-258-8805
  • Fax: 304-258-8846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17621
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: