MEDICARE: CAMILLA ELIZABETH PHARAMOND CNM RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN520777L	PA
2	367A00000X	Advanced Practice Midwife	MW008611L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	420001611	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1324617	OTHER	HIGHMARK BLUE SHIELD
2	2017306000	OTHER	INDEPENDENCE BLUE CROSS
3	2120472	OTHER	MAMSI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7732340	OTHER	AETNA PPO
6	30002954	OTHER	KEYSTONE MERCY
7	2722469	OTHER	AETNA HMO
9	3Y2715	OTHER	HEALTH NET

General Provider Information

NPI Number	:	1093799223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLA ELIZABETH PHARAMOND CNM RN

Provider Business Mailing Address
First Line	:	1098 W BALTIMORE PIKE STE 3106
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-5139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1098 W BALTIMORE PIKE STE 3106
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-5139
Country	:	US
Telephone Number	:	610-891-6240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	01/23/2024

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