Provider Demographics
NPI:1760778443
Name:CAMARA, JOAQUIN Q (BS)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:Q
Last Name:CAMARA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:JOAQUIN
Other - Middle Name:Q
Other - Last Name:CAMARA-QUINTANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-793-9166
Practice Address - Fax:401-444-2788
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16649207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery