Provider Demographics
NPI:1952021644
Name:CAMARA, OLEY M
Entity Type:Individual
Prefix:
First Name:OLEY
Middle Name:M
Last Name:CAMARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6837C RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1828
Mailing Address - Country:US
Mailing Address - Phone:202-709-0224
Mailing Address - Fax:410-946-2010
Practice Address - Street 1:6837C RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1828
Practice Address - Country:US
Practice Address - Phone:202-709-0224
Practice Address - Fax:410-946-2010
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401177014390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program