Provider Demographics
NPI:1902892292
Name:MANCINI, PAMELA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:M
Last Name:MANCINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 EMPIRE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1939
Mailing Address - Country:US
Mailing Address - Phone:540-361-1800
Mailing Address - Fax:540-361-1803
Practice Address - Street 1:4550 EMPIRE CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1939
Practice Address - Country:US
Practice Address - Phone:540-361-1800
Practice Address - Fax:540-361-1803
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043865208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6721303Medicaid
VA6721303Medicaid
370001275Medicare PIN