Provider Demographics
NPI:1083684732
Name:GUALTIERI, CAMILLO THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLO
Middle Name:THOMAS
Last Name:GUALTIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:919-933-2000
Mailing Address - Fax:919-933-2830
Practice Address - Street 1:1829 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-933-2000
Practice Address - Fax:919-933-2830
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC189572084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8937858Medicaid
E08614Medicare UPIN
NC8937858Medicaid