Basic Information
Provider Information
NPI: 1629118948
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COBB
FirstName: PAMELA
MiddleName: PENROSE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 EAST JEFFERSON STREET
Address2: KAISER PERMANENTE PPQA 6 WEST
City: ROCKVILLE
State: MD
PostalCode: 20852
CountryCode: US
TelephoneNumber: 3018166660
FaxNumber: 3018166308
Practice Location
Address1: 1011 NORTH CAPITOL STREET
Address2:  
City: WASHINGTON
State: DC
PostalCode: 20002
CountryCode: US
TelephoneNumber: 2028985426
FaxNumber: 2028985282
Other Information
ProviderEnumerationDate: 02/07/2007
LastUpdateDate: 02/04/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/04/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XD54797MDN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207X00000X0101231827VAN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207X00000XMD21961DCY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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