Provider Demographics
NPI:1770549917
Name:KAMELGARD, JOSEPH (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:KAMELGARD
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 WHITWORTH DR APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1333
Mailing Address - Country:US
Mailing Address - Phone:973-573-2634
Mailing Address - Fax:
Practice Address - Street 1:9100 WHITWORTH DR APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1333
Practice Address - Country:US
Practice Address - Phone:973-573-2634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06782900208600000X
CAC147292208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7771703Medicaid
NJ022024C2HMedicare PIN
NJ7771703Medicaid