MEDICARE: DR. CAMILLE GREEN MD

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	207R00000X	Internal Medicine Physician	25MA09296300	NJ

General Provider Information

NPI Number	:	1811293921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAMILLE GREEN MD

Provider Business Mailing Address
First Line	:	651 JOHN F KENNEDY WAY
Second Line	:
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-1262
Country	:	US
Telephone Number	:	609-835-2838
Fax Number	:	609-589-3841

Provider Business Practice Location Address
First Line	:	651 JOHN F KENNEDY WAY
Second Line	:
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-1262
Country	:	US
Telephone Number	:	609-835-2838
Fax Number	:	609-589-3841

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

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	12/30/2016

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