Healthcare Provider Details

I. General information

NPI: 1205769312
Provider Name (Legal Business Name): CAMERON DUVALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 TRICOM ST
NORTH CHARLESTON SC
29406-9171
US

IV. Provider business mailing address

150 NEWTON RD
SUMMERVILLE SC
29483-9349
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-6600
  • Fax:
Mailing address:
  • Phone: 801-347-1662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number1699759563
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: