Provider Demographics
NPI:1649270331
Name:HORTON-THOMPSON, CAMILLE (MD)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:HORTON-THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:HORTON-THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3263 COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4351
Mailing Address - Country:US
Mailing Address - Phone:703-746-0111
Mailing Address - Fax:703-746-6388
Practice Address - Street 1:3300 GALLOWS RD FL 1
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-4005
Practice Address - Fax:703-776-7068
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1649270331Medicaid
VAVAA113263Medicare PIN
L22155Medicare UPIN
VA1649270331Medicaid