Provider Demographics
NPI:1083623045
Name:CAMY, RODOLPHE (MD)
Entity Type:Individual
Prefix:
First Name:RODOLPHE
Middle Name:
Last Name:CAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODOLPHE
Other - Middle Name:
Other - Last Name:CAMY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:163 VAN BUREN ROAD
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736
Mailing Address - Country:US
Mailing Address - Phone:781-929-8544
Mailing Address - Fax:207-255-9537
Practice Address - Street 1:163 VAN BUREN ROAD,
Practice Address - Street 2:SUITE # 6
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736
Practice Address - Country:US
Practice Address - Phone:781-929-8544
Practice Address - Fax:207-255-9537
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230820-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care