Healthcare Provider Details

I. General information

NPI: 1609336759
Provider Name (Legal Business Name): CAMERON MACKENZIE TERRELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BEECHWOOD RD
CINCINNATI OH
45244-1957
US

IV. Provider business mailing address

4600 BEECHWOOD RD
CINCINNATI OH
45244-1957
US

V. Phone/Fax

Practice location:
  • Phone: 513-943-3680
  • Fax:
Mailing address:
  • Phone: 513-943-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number05474
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: