Provider Demographics
NPI:1386105278
Name:PAMEN, LARISSA NKOUAMI (MD)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:NKOUAMI
Last Name:PAMEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:NKOUAMI PAMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5141
Mailing Address - Country:US
Mailing Address - Phone:860-585-3966
Mailing Address - Fax:
Practice Address - Street 1:41 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5141
Practice Address - Country:US
Practice Address - Phone:860-585-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT82999208600000X
NJ25MA12172800208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program