Provider Demographics
NPI: | 1376525428 |
---|---|
Name: | CAMARGO, CARLOS ARTURO JR (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | CARLOS |
Middle Name: | ARTURO |
Last Name: | CAMARGO |
Suffix: | JR |
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: | PO BOX 9142 |
Mailing Address - Street 2: | MASS GENERAL PHYSICIAN ORGANIZATION |
Mailing Address - City: | CHARLESTOWN |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02129-9142 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-724-0287 |
Mailing Address - Fax: | 617-726-2894 |
Practice Address - Street 1: | 326 CAMBRIDGE ST |
Practice Address - Street 2: | STE 410 |
Practice Address - City: | BOSTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02114 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-726-5276 |
Practice Address - Fax: | 617-724-4050 |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2005-11-15 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 77397 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | J13962 | Other | BCBS MA |
MA | 3109518 | Medicaid | |
MA | 725745 | Other | TUFTS HEALTH PLAN |
MA | 725745 | Other | TUFTS HEALTH PLAN |
F61411 | Medicare UPIN |