Individual
PAMELA MARTIN PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1120 KANAWHA BLVD E, CHARLESTON, WV 25301-2400
(304) 344-3457
(304) 344-3480
Mailing address
PO BOX 11137, CHARLESTON, WV 25339-1137
(304) 344-3457
(304) 344-3480
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
19277
WV
2085R0202X
Diagnostic Radiology Physician
Primary
19277
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0122386000
—
WV
01
—
6688-0024
CAREFIRST
VA
05
—
7243863
—
VA
05
—
7243871
—
VA
05
—
7243880
—
VA
05
—
7243898
—
VA
05
—
7247371
—
VA
Enumeration date
04/18/2006
Last updated
08/04/2021
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