Individual
DR. PAMELA WAGNER VONMATTHIESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1234 LIVERMORE STREET, YELLOW SPRINGS, OH 45387
(937) 767-0147
(970) 641-9017
Mailing address
1234 LIVERMORE STREET, YELLOW SPRINGS, OH 45387
(937) 767-0147
(970) 641-9017
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35.076986
OH
207R00000X
Internal Medicine Physician
38431
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2208659
—
OH
05
—
70076341
—
CO
Enumeration date
07/01/2005
Last updated
12/23/2014
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