Provider Demographics
NPI:1548242696
Name:CAMERON, STEFFEN S (MD)
Entity Type:Individual
Prefix:
First Name:STEFFEN
Middle Name:S
Last Name:CAMERON
Suffix:
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 1:551 WABASH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-4143
Mailing Address - Country:US
Mailing Address - Phone:330-602-7531
Mailing Address - Fax:330-602-2821
Practice Address - Street 1:551 WABASH AVE NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-4143
Practice Address - Country:US
Practice Address - Phone:330-602-7531
Practice Address - Fax:330-602-2821
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061209Medicaid
G79355Medicare UPIN
OH0856242Medicare PIN