MEDICARE: DR. JAIME J CAMACHO FUENTES 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	207R00000X	Internal Medicine Physician	0101057770	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	765467	OTHER		MEDICARE GROUP

General Provider Information

NPI Number	:	1881668606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME J CAMACHO FUENTES M.D.

Provider Business Mailing Address
First Line	:	6201 LEESBURG PIKE
Second Line	:	STE 410
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2201
Country	:	US
Telephone Number	:	703-532-5044
Fax Number	:	703-532-5944

Provider Business Practice Location Address
First Line	:	6201 LEESBURG PIKE
Second Line	:	STE 410
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2201
Country	:	US
Telephone Number	:	703-532-5044
Fax Number	:	703-532-5944

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

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	11/09/2007

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