Provider Demographics
NPI:1609845544
Name:CAMILLE EYVAZZADEH MD PC
Entity Type:Organization
Organization Name:CAMILLE EYVAZZADEH MD PC
Other - Org Name:EYVAZZADEH & REILLY COLON AND RECTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EYVAZZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-866-2600
Mailing Address - Street 1:406 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1469
Mailing Address - Country:US
Mailing Address - Phone:610-866-2600
Mailing Address - Fax:610-861-7640
Practice Address - Street 1:406 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1469
Practice Address - Country:US
Practice Address - Phone:610-866-2600
Practice Address - Fax:610-861-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001564322 01Medicaid
PA852981Medicare PIN