Provider Demographics
NPI:1740391507
Name:TON, CAMVAN NU (MD)
Entity Type:Individual
Prefix:
First Name:CAMVAN
Middle Name:NU
Last Name:TON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 ARLINGTON BLVD
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044
Mailing Address - Country:US
Mailing Address - Phone:703-534-3936
Mailing Address - Fax:703-534-3936
Practice Address - Street 1:6107 ARLINGTON BLVD
Practice Address - Street 2:SUITE A & B
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044
Practice Address - Country:US
Practice Address - Phone:703-534-3936
Practice Address - Fax:703-534-3936
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226180207R00000X
CAA64566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD536101000Medicaid
VA5845581Medicaid
490623Medicare ID - Type Unspecified
MD536101000Medicaid