Provider Demographics
NPI:1225032667
Name:MCCALMONT, CAMILLA S (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:S
Last Name:MCCALMONT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3904
Mailing Address - Country:US
Mailing Address - Phone:510-527-8865
Mailing Address - Fax:510-527-4123
Practice Address - Street 1:6431 FAIRMOUNT AVE
Practice Address - Street 2:STE 3
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3624
Practice Address - Country:US
Practice Address - Phone:510-527-8865
Practice Address - Fax:510-527-4123
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48293207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A482930OtherBLUE SHIELD
CA00A482931Medicaid
CA00A482930OtherBLUE SHIELD
CA00A482931Medicaid