Provider Demographics
NPI:1790917466
Name:CAMISCIOLI, THEODORE (MD,)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:CAMISCIOLI
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 1:28 LANE OF ACRES
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3505
Mailing Address - Country:US
Mailing Address - Phone:856-428-5397
Mailing Address - Fax:856-428-5397
Practice Address - Street 1:28 LANE OF ACRES
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-3505
Practice Address - Country:US
Practice Address - Phone:856-428-5397
Practice Address - Fax:856-428-5397
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02274700207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology