Provider Demographics
NPI:1922088566
Name:KHAWAND, CAMILLE Y (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:Y
Last Name:KHAWAND
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 1:105 PINE BLUFF RD
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7160
Mailing Address - Country:US
Mailing Address - Phone:410-749-8370
Mailing Address - Fax:410-749-8910
Practice Address - Street 1:105 PINE BLUFF RD
Practice Address - Street 2:SUITE 7A
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7160
Practice Address - Country:US
Practice Address - Phone:410-749-8370
Practice Address - Fax:410-749-8910
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053452207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001142701Medicaid
VA620958OtherBCBS OF VIRGINIA
VA010116783Medicaid
MDG2250001OtherBCBS OF DC
MD003801600Medicaid
MD254QCAOtherBCBS MD
MD254QCAOtherBCBS MD
MD128MMedicare PIN