Provider Demographics
NPI:1972692234
Name:CAMP, MICHAEL ROMOLO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROMOLO
Last Name:CAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3135 OLD COURT ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3336
Mailing Address - Country:US
Mailing Address - Phone:410-486-4596
Mailing Address - Fax:410-486-4597
Practice Address - Street 1:9618 BELAIR ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-1104
Practice Address - Country:US
Practice Address - Phone:410-256-3580
Practice Address - Fax:410-529-9005
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0012892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02657Medicaid
D75252Medicare UPIN
MD02657Medicaid