Provider Demographics
NPI:1649245267
Name:CAMERON, JEFFREY C JR (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:CAMERON
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 W CHESTNUT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4658
Mailing Address - Country:US
Mailing Address - Phone:724-228-1414
Mailing Address - Fax:724-228-8579
Practice Address - Street 1:380 W CHESTNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4658
Practice Address - Country:US
Practice Address - Phone:724-228-1414
Practice Address - Fax:724-228-8579
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103207420Medicaid
PA108652N79Medicare PIN
PA103207420Medicaid