Healthcare Provider Details

I. General information

NPI: 1215315809
Provider Name (Legal Business Name): DEMITRIO JAMES CAMARENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE STREET, #213 ST. ELIZABETH'S MEDICAL CENTER, ANESTHESIOLOGY
BRIGHTON MA
02135
US

IV. Provider business mailing address

4 LANGLEY RD APT. 2
BRIGHTON MA
02135-3011
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2777
  • Fax:
Mailing address:
  • Phone: 303-489-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number268684
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: