Provider Demographics
NPI:1952491730
Name:CAMACHO, JEANETTE M (MD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:856-968-8499
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2506
Practice Address - Fax:856-968-8312
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA58158207ZP0102X, 207ZP0213X
PAMD045264E207ZP0102X, 207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
24974OtherUNIVERSITY HEALTHPLAN
XK5420OtherHEALTHNET
0295554000OtherAMERIHEALTH HMO, KEYSTONE, IBC
P694316OtherOXFORD
010003886OtherAMERICHOICE
1012256OtherHORIZON NJ HEALTH
1448372OtherUNITED HEALTHCARE
NJ5290601Medicaid
64713OtherAMERIHEALTH PPO
NJ064713 CTDMedicare PIN
64713OtherAMERIHEALTH PPO