Provider Demographics
NPI:1801898804
Name:CAMACHO-PANTOJA, JOSE A (MD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:CAMACHO-PANTOJA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:46 ALBION ST
Mailing Address - Street 2:SOUTHWEST COMMUNITY HEALTH CENTER, INC
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-2602
Mailing Address - Country:US
Mailing Address - Phone:203-330-6000
Mailing Address - Fax:203-330-6008
Practice Address - Street 1:46 ALBION ST
Practice Address - Street 2:SOUTHWEST COMMUNITY HEALTH CENTER, INC
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2602
Practice Address - Country:US
Practice Address - Phone:203-330-6000
Practice Address - Fax:203-330-6008
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2015-08-13
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Provider Licenses
StateLicense IDTaxonomies
CT0239042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT260004299Medicare PIN
CTE11494Medicare UPIN