Provider Demographics
NPI:1750334959
Name:CAMUNAS, JOSEPH ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:CAMUNAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:STE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD
Practice Address - Street 2:SUITE 310
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4253
Practice Address - Country:US
Practice Address - Phone:864-455-8300
Practice Address - Fax:864-455-8310
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12688208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00003466OtherRR MEDICARE
SC126884Medicaid
SCB923563640Medicare PIN
SCP00003466OtherRR MEDICARE
SCP00801304OtherRR MEDICARE
SCB923567951Medicare PIN
SC5720092OtherAETNA
SCP00003466OtherRR MEDICARE
SCB92356Medicare UPIN
SCB923563640Medicare PIN