Provider Demographics
NPI:1912067836
Name:INTROCASO, CAMILLE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:ELIZABETH
Last Name:INTROCASO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRICK RD STE 306
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2146
Mailing Address - Country:US
Mailing Address - Phone:856-452-8586
Mailing Address - Fax:856-596-7194
Practice Address - Street 1:100 BRICK RD STE 306
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2146
Practice Address - Country:US
Practice Address - Phone:856-452-8586
Practice Address - Fax:856-596-7194
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440212207N00000X
NJ25MA10827300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology