Healthcare Provider Details

I. General information

NPI: 1417365370
Provider Name (Legal Business Name): CAMILLE V EDWARDS MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMILLE VANESSA EDWARDS MBBS

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3823
  • Fax: 617-751-7070
Mailing address:
  • Phone: 617-632-3823
  • Fax: 617-751-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number283337
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberET90-064
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number283337
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberET90-064
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number283337
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberET90-064
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: