Provider Demographics
NPI:1871878785
Name:HAIN-KOENIGSBURG, PAMELA (PHD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HAIN-KOENIGSBURG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 PROGRESS WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6464
Mailing Address - Country:US
Mailing Address - Phone:410-549-5181
Mailing Address - Fax:410-549-5182
Practice Address - Street 1:1380 PROGRESS WAY
Practice Address - Street 2:STE 101
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6464
Practice Address - Country:US
Practice Address - Phone:410-549-5181
Practice Address - Fax:410-549-5182
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04923103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD669LMedicare UPIN