Provider Demographics
NPI:1033190665
Name:ELLIOTT, CAMERON A (DPM)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 STATE RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1427
Mailing Address - Country:US
Mailing Address - Phone:330-929-3331
Mailing Address - Fax:330-929-5408
Practice Address - Street 1:2127 STATE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1427
Practice Address - Country:US
Practice Address - Phone:330-929-3331
Practice Address - Fax:330-929-5408
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001546E213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00413731OtherMEDICARE RR
OH0147326Medicaid
OH0014425Medicare PIN
OH0014423Medicare PIN
OH0147326Medicaid