Provider Demographics
NPI:1144204298
Name:CAMARA, CHRISTINA (PA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:CAMARA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:VAN DALSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3550 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1078
Mailing Address - Country:US
Mailing Address - Phone:413-858-7400
Mailing Address - Fax:413-746-0380
Practice Address - Street 1:3550 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1078
Practice Address - Country:US
Practice Address - Phone:413-858-7400
Practice Address - Fax:413-746-0380
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1178363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS86432Medicare UPIN
MAAP1757Medicare ID - Type Unspecified