MEDICARE: PAMELA J GAVIN NP

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	363LF0000X	Family Nurse Practitioner	30521	WV

General Provider Information

NPI Number	:	1942290317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA J GAVIN NP

Provider Business Mailing Address
First Line	:	12931 OAK HILL AVE
Second Line	:
City	:	HAGERSTOWN
State	:	MD
Zip	:	21742-2914
Country	:	US
Telephone Number	:	301-797-9600
Fax Number	:	301-797-3854

Provider Business Practice Location Address
First Line	:	103 MARCLEY DR
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-2977
Country	:	US
Telephone Number	:	304-263-0964
Fax Number	:	304-267-3899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	06/02/2010

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