Provider Demographics
NPI:1881668606
Name:CAMACHO FUENTES, JAIME J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:J
Last Name:CAMACHO FUENTES
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:6201 LEESBURG PIKE
Mailing Address - Street 2:STE 410
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2201
Mailing Address - Country:US
Mailing Address - Phone:703-532-5044
Mailing Address - Fax:703-532-5944
Practice Address - Street 1:6201 LEESBURG PIKE
Practice Address - Street 2:STE 410
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2201
Practice Address - Country:US
Practice Address - Phone:703-532-5044
Practice Address - Fax:703-532-5944
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
765467OtherMEDICARE GROUP
G89824Medicare UPIN
765467OtherMEDICARE GROUP