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NPI Code Detail

MEDICARE: LEONA MARIE CAMMOCK MD

MEDICARE: LEONA MARIE CAMMOCK 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
1207Q00000XFamily Medicine Physician35121596OH
2208M00000XHospitalist Physician2021-03450NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346238326
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONA MARIE CAMMOCK MD
Provider Business Mailing Address
First Line : MEDICAL CENTER BLVD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27157-0001
Country : US
Telephone Number : 336-651-8100
Fax Number : 336-716-0030
Provider Business Practice Location Address
First Line : 1370 W D ST
Second Line :
City : NORTH WILKESBORO
State : NC
Zip : 28659-3506
Country : US
Telephone Number : 336-651-8100
Fax Number : 336-716-0030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 05/08/2023

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