Provider Demographics
NPI:1487307922
Name:JAN, PAM A
Entity type:Individual
Prefix:
First Name:PAM
Middle Name:A
Last Name:JAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 WILLOWBROOK RD FL 2
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2506
Mailing Address - Country:US
Mailing Address - Phone:240-964-8417
Mailing Address - Fax:240-964-8415
Practice Address - Street 1:12501 WILLOWBROOK RD FL 2
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2506
Practice Address - Country:US
Practice Address - Phone:240-964-8417
Practice Address - Fax:240-964-8415
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty