Provider Demographics
NPI:1396863056
Name:WOODBURY, CAMILLE
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
Last Name:WOODBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5586 LEEWARD LN
Mailing Address - Street 2:PO BOX 400
Mailing Address - City:TILGHMAN
Mailing Address - State:MD
Mailing Address - Zip Code:21671-1154
Mailing Address - Country:US
Mailing Address - Phone:410-886-9860
Mailing Address - Fax:410-886-2828
Practice Address - Street 1:5586 LEEWARD LN
Practice Address - Street 2:
Practice Address - City:TILGHMAN
Practice Address - State:MD
Practice Address - Zip Code:21671-1154
Practice Address - Country:US
Practice Address - Phone:410-886-9860
Practice Address - Fax:410-886-2828
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD228842084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD644857Medicare UPIN