Provider Demographics
NPI:1659323327
Name:CAMDEN, TIMOTHY H (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:H
Last Name:CAMDEN
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 1:200 LERNA RD S
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9388
Mailing Address - Country:US
Mailing Address - Phone:217-258-5960
Mailing Address - Fax:
Practice Address - Street 1:200 LERNA RD S
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9388
Practice Address - Country:US
Practice Address - Phone:217-258-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109079Medicaid
ILH34035Medicare UPIN
IL036109079Medicaid
ILK11698Medicare PIN