Healthcare Provider Details

I. General information

NPI: 1114188455
Provider Name (Legal Business Name): MARC ANTHONY CAMACHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
CONCORD NH
03301-2548
US

IV. Provider business mailing address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, GROUND FLOOR
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 603-415-6400
  • Fax: 603-227-7595
Mailing address:
  • Phone: 603-415-6400
  • Fax: 603-227-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number20465
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101253936
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: