Provider Demographics
NPI:1659357309
Name:OCAMPO, MA CRISTINA MERERIA (MD)
Entity Type:Individual
Prefix:
First Name:MA CRISTINA
Middle Name:MERERIA
Last Name:OCAMPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MA CRISTINA
Other - Middle Name:LAVAPIE
Other - Last Name:MERERIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 746724
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6724
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:6824 HARRISBURG RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-3389
Practice Address - Country:US
Practice Address - Phone:704-870-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079826207Q00000X
MO2007010571207Q00000X
NC202103242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1659357309Medicaid
MOP00635283OtherRAILROAD MEDICARE
MO310385280Medicare PIN
MO1659357309Medicaid