Individual
PAMELA E JACKSON
Active
Individual
PAMELA E JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101271362
VA
207R00000X
Internal Medicine Physician
035139
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004235736
COMMUNITY HEALTH NETWORK
—
05
—
004235736
—
CT
01
—
010035139CT03
ANTHEM BLUE CROSS BLUE SH
—
01
—
035139
CT CARE
—
01
—
10Q3466
HEALTHNET
—
01
—
3171723
AETNA
—
01
—
P3597371
OXFORD
—
Enumeration date
09/11/2006
Last updated
12/06/2023
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