Provider Demographics
NPI:1801857925
Name:EYVAZZADEH, CAMILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
Last Name:EYVAZZADEH
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 1:406 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1469
Mailing Address - Country:US
Mailing Address - Phone:610-866-2600
Mailing Address - Fax:610-861-7640
Practice Address - Street 1:406 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1469
Practice Address - Country:US
Practice Address - Phone:610-866-2600
Practice Address - Fax:610-861-7640
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025523E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01047301OtherDR E CAPITAL
PA4548OtherDR E HIGHMARK
PA0004548OtherDR E KHP
PA004548LL2Medicare PIN
PAB30165Medicare UPIN