MEDICARE: PAMELA KAW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	239161	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10108518	OTHER	NY	CDPHP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205100237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMELA KAW MD

Provider Business Mailing Address
First Line	:	451 HOOSICK ST
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-2100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 STARBUCK DR
Second Line	:
City	:	GREEN ISLAND
State	:	NY
Zip	:	12183-1280
Country	:	US
Telephone Number	:	518-274-3390
Fax Number	:	518-274-3398

Authorized Official
Title or Position	:	OWNER
Name	:	PAMELA KAW
Credential	:
Telephone Number	:	518-274-3390

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	12/26/2021

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