MEDICARE: CATHERINE NOWELL CAMERON PA

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	363A00000X	Physician Assistant		VA

General Provider Information

NPI Number	:	1386148112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE NOWELL CAMERON PA

Provider Business Mailing Address
First Line	:	3501 CHEVINGTON RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4928
Country	:	US
Telephone Number	:	910-228-6656
Fax Number	:

Provider Business Practice Location Address
First Line	:	11800 SUNRISE VALLEY DR STE 800
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-5320
Country	:	US
Telephone Number	:	703-709-1114
Fax Number	:

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

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	03/19/2018

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