We present griz_P1_ light curves of 146 spectroscopically confirmed Type Ia supernovae (SNe Ia; 0.03<z<0.65) discovered during the first 1.5yr 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 PS1 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 {omega}=-1.120_-0.206_^+0.360^(Stat)_-0.291_^+0.269^(Sys). When combined with BAO+CMB(Planck)+H_0_, the analysis yields {Omega}_M_=0.280_-0.012_^+0.013^ and {omega}=-1.166_-0.069_^+0.072^ including all identified systematics. The value of w is inconsistent with the cosmological constant value of -1 at the 2.3{sigma} level. Tension endures after removing either the baryon acoustic oscillation (BAO) or the H_0_ constraint, though it is strongest when including the H_0_ constraint. If we include WMAP9 cosmic microwave background (CMB) constraints instead of those from Planck, we find {omega}=-1.124_-0.065_^+0.083^, which diminishes the discord to <2{sigma}. We cannot conclude whether the tension with flat {Lambda}CDM 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.