Healthcare Provider Details

I. General information

NPI: 1487202735
Provider Name (Legal Business Name): AIDEN R CAMARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E COLLEGE ST
BRIDGEWATER VA
22812-1511
US

IV. Provider business mailing address

1034 BLUE RIDGE DR APT 6
HARRISONBURG VA
22802-4980
US

V. Phone/Fax

Practice location:
  • Phone: 540-828-8000
  • Fax:
Mailing address:
  • Phone: 802-779-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: