MEDICARE: MS. MARIETTA L CAMERON M.S.

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	1787909	NY

General Provider Information

NPI Number	:	1972846996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIETTA L CAMERON M.S.

Provider Business Mailing Address
First Line	:	PO BOX 920213
Second Line	:
City	:	ARVERNE
State	:	NY
Zip	:	11692-0213
Country	:	US
Telephone Number	:	347-524-4507
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 FULTON ST
Second Line	:	3D
City	:	BROOKLYN
State	:	NY
Zip	:	11233-2254
Country	:	US
Telephone Number	:	347-524-4507
Fax Number	:

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

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	05/23/2013

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