Provider Demographics
NPI:1013102524
Name:CAMERON N. CARMODY, M.D., P.A.
Entity Type:Organization
Organization Name:CAMERON N. CARMODY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-370-3535
Mailing Address - Street 1:17051 DALLAS PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-7108
Mailing Address - Country:US
Mailing Address - Phone:214-370-3535
Mailing Address - Fax:214-370-0004
Practice Address - Street 1:17051 DALLAS PKWY STE 400
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7108
Practice Address - Country:US
Practice Address - Phone:214-370-3535
Practice Address - Fax:214-370-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF49109Medicare UPIN
TX00799RMedicare PIN