=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912910555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID L KAMELHAR MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 11/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 PARK AVE S SUITE 701
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-8412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-685-6611
-----------------------------------------------------
Fax | 212-685-6626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 PARK AVE S STE 701
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-8412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-685-6611
-----------------------------------------------------
Fax | 212-685-6626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. DAVID KAMELHAR
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 212-685-6611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------