MEDICARE: MS. DOVIYALE L CAMMON

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	174400000X	Specialist	33.017855C-D	OH

General Provider Information

NPI Number	:	1619209632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOVIYALE L CAMMON

Provider Business Mailing Address
First Line	:	4919 WARRENSVILLE CENTER RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-4354
Country	:	US
Telephone Number	:	440-475-9977
Fax Number	:	216-475-9969

Provider Business Practice Location Address
First Line	:	4919 WARRENSVILLE CENTER RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-4354
Country	:	US
Telephone Number	:	440-475-9977
Fax Number	:	216-475-9969

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

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	02/01/2010

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