Provider Demographics
NPI:1700871985
Name:CAMACHO, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8300
Mailing Address - Fax:814-410-8331
Practice Address - Street 1:126 E CHURCH ST
Practice Address - Street 2:SUITE 3100
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2271
Practice Address - Country:US
Practice Address - Phone:814-445-3535
Practice Address - Fax:814-445-3245
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073437L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA219062OtherUPMC HEALTH PLAN
PA0018425730001Medicaid
PA118690OtherMEDPLUS
PA1517646OtherGATEWAY HEALTH PLAN
PA219062OtherUPMC HEALTH PLAN