Basic Information
Provider Information
NPI: 1487719027
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TROYER
FirstName: PAMELA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 147 MILK ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021094806
CountryCode: US
TelephoneNumber: 6174212508
FaxNumber: 6174213487
Practice Location
Address1: 147 MILK ST
Address2:  
City: BOSTON
State: MA
PostalCode: 021094806
CountryCode: US
TelephoneNumber: 6174212508
FaxNumber: 6174213487
Other Information
ProviderEnumerationDate: 12/26/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X137MAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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