MEDICARE: CAMILLA S MCCALMONT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	A48293	CA
2	207N00000X	Dermatology Physician	A48293	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A482930	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225032667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLA S MCCALMONT MD

Provider Business Mailing Address
First Line	:	145 HILLSIDE AVE
Second Line	:
City	:	PIEDMONT
State	:	CA
Zip	:	94611-3904
Country	:	US
Telephone Number	:	510-527-8865
Fax Number	:	510-527-4123

Provider Business Practice Location Address
First Line	:	6431 FAIRMOUNT AVE
Second Line	:	STE 3
City	:	EL CERRITO
State	:	CA
Zip	:	94530-3624
Country	:	US
Telephone Number	:	510-527-8865
Fax Number	:	510-527-4123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	05/29/2020

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Directions to “ CAMILLA S MCCALMONT MD” Practice Location

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