Provider Demographics
NPI:1023198066
Name:CAMILLE DILLARD DO HEALTH & WELLNESS PC
Entity Type:Organization
Organization Name:CAMILLE DILLARD DO HEALTH & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:888-338-9355
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-0095
Mailing Address - Country:US
Mailing Address - Phone:315-736-2080
Mailing Address - Fax:315-736-2162
Practice Address - Street 1:900 ERIE BLVD W
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2904
Practice Address - Country:US
Practice Address - Phone:888-338-9355
Practice Address - Fax:315-337-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG90475Medicare UPIN
NYRA6535Medicare PIN