Provider Demographics
NPI:1760416150
Name:CAMP, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:CAMP
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1423 E FRANKLIN ST
Practice Address - Street 2:STE D
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5266
Practice Address - Country:US
Practice Address - Phone:704-289-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00432Medicaid
NCP00399296OtherRR MEDICARE
NC8920987Medicaid
NC1760416150Medicaid
NC20987OtherBC BS NC
NC110148807OtherRR MEDICARE
NC1760416150Medicaid
NC2199652DMedicare PIN
NCF82507Medicare UPIN
SCN00432Medicaid