Provider Demographics
NPI:1912391186
Name:CAMERON, MICHAEL C
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:CAMERON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7340
Mailing Address - Country:US
Mailing Address - Phone:212-466-6550
Mailing Address - Fax:212-466-6554
Practice Address - Street 1:200 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7340
Practice Address - Country:US
Practice Address - Phone:212-466-6550
Practice Address - Fax:212-466-6554
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297241207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY297241OtherNEW YORK MEDICAL LICENSE NUMBER