Provider Demographics
NPI:1144225053
Name:TAWIL, CAMILLE E (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:E
Last Name:TAWIL
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 1:3730 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1844
Mailing Address - Country:US
Mailing Address - Phone:410-235-0999
Mailing Address - Fax:877-423-2298
Practice Address - Street 1:3730 FALLS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1844
Practice Address - Country:US
Practice Address - Phone:410-235-0999
Practice Address - Fax:877-423-2298
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD68176207R00000X
OH35082765T207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144225053OtherAETNA PPO
DCS206 0002OtherCAREFIRST
MD150888ZDKAOtherMEDICARE
1144225053OtherAETNA HMO
MD419760700OtherMEDICAL ASSISTANCE
209064OtherEHP/JHH
GAP00736743OtherRAILROAD MEDICARE
1144225053OtherCIGNA/GREAT-WEST HEALTHCARE
1144225053OtherNCPPO
MD95047501OtherCAREFIRST
1144225053OtherMEDSTAR FAMILY CHOICE
MD494786OtherMEDICARE UPIN