Provider Demographics
NPI:1366405987
Name:BENSEN, PAMELA P (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:P
Last Name:BENSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 EGRET LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO JUNCTION
Mailing Address - State:VA
Mailing Address - Zip Code:24529-3505
Mailing Address - Country:US
Mailing Address - Phone:424-738-5584
Mailing Address - Fax:
Practice Address - Street 1:132 EGRET LN
Practice Address - Street 2:
Practice Address - City:BUFFALO JUNCTION
Practice Address - State:VA
Practice Address - Zip Code:24529-3505
Practice Address - Country:US
Practice Address - Phone:424-738-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00536207P00000X
VA0101248270207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC264957Medicaid
NC5900395Medicaid
GA031755513BMedicaid
SC264957Medicaid
SC5965Medicare PIN
GA031755513BMedicaid