Basic Information
| Provider Information | |||||||||
| NPI: | 1184621633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODSON | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10403 HOSPITAL DR | ||||||||
| Address2: | STE G4 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207353134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018563019 | ||||||||
| FaxNumber: | 3018569370 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 SWAN CREEK RD E | ||||||||
| Address2: | |||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207445250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012921590 | ||||||||
| FaxNumber: | 3012033347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 05/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0059195 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 61840501-KR10ME | 01 | MD | BCBS MARYLAND FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND | OTHER | 1851473722 | 01 | MD | GROUP NPI - MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND | OTHER | P00196013 | 01 | MD | MEDICARE RAILROAD | OTHER | 1174568091 | 01 | MD | GROUP NPI - FORT WASHINGTON FAMILY MEDICAL CENTER | OTHER | B776-0018 | 01 | DC | BCBS NCA FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND | OTHER | 401390500 | 05 | MD | MEDICAID |