We present griz sub(P1) light curves of 146 spectroscopically confirmed Type Ia supernovae (SNe Ia; 0.03 < z < 0.65) discovered during the first 1.5 yr of the Pan-STARRS1 Medium Deep Survey. The Pan-STARRS1 natural photometric system is determined by a combination of on-site measurements of the instrument response function and observations of spectrophotometric standard stars. We find that the systematic uncertainties in the photometric system are currently 1.2% without accounting for the uncertainty in the Hubble Space Telescope Calspec definition of the AB system. A Hubble diagram is constructed with a subset of 113 out of 146 SNe Ia that pass our light curve quality cuts. The cosmological fit to 310 SNe Ia (113 PSI SNe Ia + 222 light curves from 197 low-z SNe Ia), using only supernovae (SNe) and assuming a constant dark energy equation of state and flatness, yields w = -1.120 super(+0.360) sub(-0.206)(Stat) super(+0.269) sub(-0.291)(Sys). When combined with BAO+CMB(Planck)+H sub(0), the analysis yields Omega sub(M) = 0.280 super(0.013) sub(-0.012) and w = 1.166 super(+0.072) sub(-0.069) including all identified systematics. The value of w is inconsistent with the cosmological constant value of -1 at the 2.3sigma level. Tension endures after removing either the baryon acoustic oscillation (BAO) or the H sub(0) constraint, though it is strongest when including the H sub(0) constraint. If we include WMAP9 cosmic microwave background (CMB) constraints instead of those from Planck, we find w = -1.124 super(+0.083) sub(-0.065) which diminishes the discord to <2sigma. We cannot conclude whether the tension with flat ACDM is a feature of dark energy, new physics, or a combination of chance and systematic errors. The full Pan-STARRS1 SN sample with ~three times as many SNe should provide more conclusive results.