Provider Demographics
NPI:1376519421
Name:ROBERTS, CAMILLE I (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:I
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:405 GROVE ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1270
Mailing Address - Country:US
Mailing Address - Phone:508-890-5500
Mailing Address - Fax:508-890-5505
Practice Address - Street 1:405 GROVE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1270
Practice Address - Country:US
Practice Address - Phone:508-890-5500
Practice Address - Fax:508-890-5505
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA223309207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
2101513OtherMEDICAID WELFARE
AA30837OtherHARVARD PILGRIM HEALTHCAR
470259OtherTUFTS HEALTH PLAN
7668645OtherAETNA US HEALTHCARE
787925OtherMVP HEALTH CARE
J28697OtherBLUE CROSS ELECT
042472266OtherTRICARE CHAMPUS
042472266OtherUNITED HEALTHCARE
2283928OtherFIRST HEALTH
87361OtherHEALTHY START
92299OtherFALLON COMMUNITY HEALTH
J28697OtherBLUE SHIELD HMO BLUE
J28697OtherBLUE SHIELD INDEMNITY
1212746OtherCIGNA HEALTH PLAN
87361OtherCHILDRENS MEDICAL SECURIT
042472266OtherTHREE RIVERS
MA2101513Medicaid
042472266OtherUNITED HEALTHCARE
787925OtherMVP HEALTH CARE