MEDICARE: DR. CAMILLE C WOODSON M.D.

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	207Q00000X	Family Medicine Physician	D0059195	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00196013	OTHER	MD	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61840501-KR10ME	OTHER	MD	BCBS MARYLAND FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
2	1851473722	OTHER	MD	GROUP NPI - MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
4	1174568091	OTHER	MD	GROUP NPI - FORT WASHINGTON FAMILY MEDICAL CENTER
5	B776-0018	OTHER	DC	BCBS NCA FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184621633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMILLE C WOODSON M.D.

Provider Business Mailing Address
First Line	:	10403 HOSPITAL DR
Second Line	:	STE G4
City	:	CLINTON
State	:	MD
Zip	:	20735-3134
Country	:	US
Telephone Number	:	301-856-3019
Fax Number	:	301-856-9370

Provider Business Practice Location Address
First Line	:	900 SWAN CREEK RD E
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5250
Country	:	US
Telephone Number	:	301-292-1590
Fax Number	:	301-203-3347

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	05/14/2009

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