Provider Demographics
NPI:1184621633
Name:WOODSON, CAMILLE C (MD)
Entity type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:C
Last Name:WOODSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10403 HOSPITAL DR
Mailing Address - Street 2:STE G4
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3134
Mailing Address - Country:US
Mailing Address - Phone:301-856-3019
Mailing Address - Fax:301-856-9370
Practice Address - Street 1:900 SWAN CREEK RD E
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5250
Practice Address - Country:US
Practice Address - Phone:301-292-1590
Practice Address - Fax:301-203-3347
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2009-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD61840501-KR10MEOtherBCBS MARYLAND FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
MD1851473722OtherGROUP NPI - MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
MDP00196013OtherMEDICARE RAILROAD
MD1174568091OtherGROUP NPI - FORT WASHINGTON FAMILY MEDICAL CENTER
DCB776-0018OtherBCBS NCA FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
MD401390500Medicaid
MD011283M16Medicare PIN
MD1174568091OtherGROUP NPI - FORT WASHINGTON FAMILY MEDICAL CENTER