Provider Demographics
NPI:1972584639
Name:CAMERON, MELINDA SUE (MD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:CAMERON
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 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0034
Mailing Address - Fax:716-323-0292
Practice Address - Street 1:1001 MAIN ST FL 5
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0034
Practice Address - Fax:716-323-0292
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01195555Medicaid
070731000055OtherFIDELIS
1210536OtherIHA
000510831002OtherBC/BS
PA0018716190001Medicaid
00010024501OtherUNIVERA
040426002225OtherFIDELIS
00010024501OtherUNIVERA
040426002225OtherFIDELIS