Provider Demographics
NPI:1700877081
Name:CAMERON, KATHRYN E (PA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:YOUNGHANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:44055 RIVERSIDE PKWY STE 238
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5178
Practice Address - Country:US
Practice Address - Phone:703-858-8878
Practice Address - Fax:703-858-8170
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030363363A00000X
VA0110004916363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
016002W15Medicare ID - Type Unspecified
Q35924Medicare UPIN