Healthcare Provider Details

I. General information

NPI: 1710271838
Provider Name (Legal Business Name): CAMERON CASEY GILMORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 ROCK SPRINGS RD
CONOWINGO MD
21918-1352
US

IV. Provider business mailing address

49 ROCK SPRINGS RD
CONOWINGO MD
21918-1352
US

V. Phone/Fax

Practice location:
  • Phone: 410-378-9696
  • Fax: 410-378-9922
Mailing address:
  • Phone: 410-378-9696
  • Fax: 410-378-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.059652
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0078150
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0011119
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: