Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0420011790 | VT |
N | 208000000X | Pediatrician | 283535 | MA |
N | 2080P0208X | Pediatric Infectious Diseases | 271403 | MA |
Y | 2080P0208X | Pediatric Infectious Diseases | 283535 | MA |
NPI | 1619163573 |
---|---|
Provider Name | Dr. Ingrid Yolanda Camelo |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2007 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) | VT |