Provider Demographics
NPI:1922083633
Name:WOODLIEF, CAMERON M (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:M
Last Name:WOODLIEF
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 1:6465 E BROAD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1576
Mailing Address - Country:US
Mailing Address - Phone:614-322-9640
Mailing Address - Fax:614-322-9641
Practice Address - Street 1:6465 E BROAD ST
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1576
Practice Address - Country:US
Practice Address - Phone:614-322-9640
Practice Address - Fax:614-322-9641
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-7796207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2199688Medicaid
OHH13346Medicare UPIN
OH4016404Medicare PIN