Provider Demographics
NPI:1841492774
Name:CAMERON, JEFFREY STUART (RPA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:STUART
Last Name:CAMERON
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-5006
Mailing Address - Country:US
Mailing Address - Phone:518-698-5719
Mailing Address - Fax:
Practice Address - Street 1:634 PLANK RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2033
Practice Address - Country:US
Practice Address - Phone:518-388-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicare PIN