Provider Demographics
NPI:1174674949
Name:JOSEPH CAMA MD
Entity Type:Organization
Organization Name:JOSEPH CAMA MD
Other - Org Name:CARIBOU MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-265-7000
Mailing Address - Street 1:520 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1662
Mailing Address - Country:US
Mailing Address - Phone:570-265-7000
Mailing Address - Fax:
Practice Address - Street 1:520 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1662
Practice Address - Country:US
Practice Address - Phone:570-265-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39D1012554291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019672550001Medicaid
PA=========OtherTAX ID #