Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0102201592 | VA |
NPI | 1003810862 |
---|---|
Provider Name | Camron L Johnson Privitera |
First Address | Roanoke, VA 24013-2218 |
Second Address | Roanoke, VA 24013-2218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010072701 | (05) | VA |
139824 | ANTHEM (01) | VA |
244013 | SOUTHERN HEALTH (01) | VA |
54088505618 | JOHN DEERE (01) | VA |
6830577 | CIGNA (01) | VA |
7861556 | AETNA (01) | VA |
H60214 | (02) | VA |