Provider Demographics
NPI:1366475469
Name:CAMERON, SANDRA D (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:CAMERON
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 1:2150 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104
Mailing Address - Country:US
Mailing Address - Phone:413-731-5663
Mailing Address - Fax:413-731-9783
Practice Address - Street 1:2150 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3300
Practice Address - Country:US
Practice Address - Phone:413-731-5663
Practice Address - Fax:413-731-9783
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156320207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA23514OtherHEALTH NEW ENGLAND
MAJ19677OtherBLUE CROSS BLUE SHIELD MA
MA793608OtherTUFTS HEALTH PLAN
CT010035096CT01OtherBLUE CROSS BLUE SHIELD CT
MA3185940Medicaid
CT010035096CT01OtherBLUE CROSS BLUE SHIELD CT
MA3185940Medicaid