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NPI Code Detail

MEDICARE: CAMILLE LAUREN CONNELLY M.D.

MEDICARE: CAMILLE LAUREN CONNELLY 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
1207X00000XOrthopaedic Surgery PhysicianMD60424676WA
2207XX0004XOrthopaedic Foot and Ankle Surgery PhysicianMD60424676WA

General Provider Information

NPI Number : 1194024448
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMILLE LAUREN CONNELLY M.D.
Provider Business Mailing Address
First Line : 1400 E KINCAID ST
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98274-4127
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 901 S 5TH ST
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98274-3942
Country : US
Telephone Number : 360-424-7041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2011
Last Update Date : 09/30/2025

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Directions to “ CAMILLE LAUREN CONNELLY M.D.” Practice Location

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