MEDICARE: CAMERON ZIEGLER PSY.D.

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	103TC0700X	Clinical Psychologist	PS016600	PA

General Provider Information

NPI Number	:	1467975029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON ZIEGLER PSY.D.

Provider Business Mailing Address
First Line	:	2966 PENNVIEW AVE
Second Line	:
City	:	BROOMALL
State	:	PA
Zip	:	19008-1126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-6008
Country	:	US
Telephone Number	:	484-645-6040
Fax Number	:

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

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	03/17/2018

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