Provider Demographics
NPI:1730480351
Name:MCCAMMON, HORACE A
Entity Type:Individual
Prefix:MR
First Name:HORACE
Middle Name:A
Last Name:MCCAMMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16109 ARROWROOT CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3840
Mailing Address - Country:US
Mailing Address - Phone:301-613-0075
Mailing Address - Fax:301-218-1226
Practice Address - Street 1:16109 ARROWROOT CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3840
Practice Address - Country:US
Practice Address - Phone:301-613-0075
Practice Address - Fax:301-218-1226
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0997755247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist